1740478270 NPI number — FIRST IDEAL ENTERPRISES INC.

Table of content: (NPI 1740478270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740478270 NPI number — FIRST IDEAL ENTERPRISES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST IDEAL ENTERPRISES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IDEAL HOME PHYSICIANS PC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740478270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251062
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
W BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48325-1062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-440-0920
Provider Business Mailing Address Fax Number:
248-440-0929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21700 NORTHWESTERN HWY
Provider Second Line Business Practice Location Address:
SUITE 801
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-440-0920
Provider Business Practice Location Address Fax Number:
248-440-0929
Provider Enumeration Date:
10/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSHIYOYE
Authorized Official First Name:
ADEKUNLE
Authorized Official Middle Name:
EMMANUEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-440-0920

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  AO060924 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0F33532 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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