Kustom Made LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

KUSTOM MADE LLC

Practice address

21841 Kenosha St
Oak Park, MI 48237-2651

Phone

(248) 890-9660

NPI assigned

Mar 13, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Patrice Coates

Title

Ceo

Phone

(248) 890-9660

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1124776828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21841 KENOSHA ST",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372651",
            "telephone_number": "248-890-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21841 KENOSHA ST",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372651",
            "telephone_number": "248-890-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUSTOM MADE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-13",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "COATES",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-890-9660",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Prosthetist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1962840124",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info.kustommade@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "21841 Kenosha St",
            "city": "Oak Park",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482372651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.