Provider Demographics
NPI:1750608477
Name:PROS-TECH, INC.
Entity type:Organization
Organization Name:PROS-TECH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:GIRARDOT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:248-680-2800
Mailing Address - Street 1:1717 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2149
Mailing Address - Country:US
Mailing Address - Phone:248-680-2800
Mailing Address - Fax:248-680-2804
Practice Address - Street 1:13850 E 12 MILE RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3730
Practice Address - Country:US
Practice Address - Phone:586-541-1040
Practice Address - Fax:586-552-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0372180002Medicare NSC