Healthcare Provider Details

I. General information

NPI: 1912766205
Provider Name (Legal Business Name): NSUHODEIDEM OKON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 OCONNOR AVE
ALLEN PARK MI
48101-2717
US

IV. Provider business mailing address

15545 OCONNOR AVE
ALLEN PARK MI
48101-2717
US

V. Phone/Fax

Practice location:
  • Phone: 586-345-4641
  • Fax:
Mailing address:
  • Phone: 586-345-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: