1366240236 NPI number — IEP MCO ORTHOPEDIC URGENT CARE PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366240236 NPI number — IEP MCO ORTHOPEDIC URGENT CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IEP MCO ORTHOPEDIC URGENT CARE PLLC
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:
Provider Other Organization Name Type Code:
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:
1366240236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37000 GRAND RIVER AVE STE 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48335-2868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-536-2127
Provider Business Mailing Address Fax Number:
248-893-6952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48301-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-997-4690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2025

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
248-536-2127

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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