Provider Demographics
NPI:1033299599
Name:MARIE PITKO
Entity type:Organization
Organization Name:MARIE PITKO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PITKO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:586-228-9740
Mailing Address - Street 1:42524 HAYES RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3643
Mailing Address - Country:US
Mailing Address - Phone:586-228-9740
Mailing Address - Fax:586-286-1507
Practice Address - Street 1:42524 HAYES RD STE 300
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3643
Practice Address - Country:US
Practice Address - Phone:586-228-9740
Practice Address - Fax:586-286-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E00320OtherBLUE CROSS
MI862656278Medicaid
MI0730510001Medicare NSC