Healthcare Provider Details

I. General information

NPI: 1366240236
Provider Name (Legal Business Name): IEP MCO ORTHOPEDIC URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 TELEGRAPH RD
BLOOMFIELD HILLS MI
48301-1716
US

IV. Provider business mailing address

PO BOX 675560
DETROIT MI
48267-5560
US

V. Phone/Fax

Practice location:
  • Phone: 248-997-4690
  • Fax:
Mailing address:
  • Phone: 248-536-2127
  • Fax: 248-893-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID GERALD HALL
Title or Position: MANAGER
Credential: MD
Phone: 248-536-2127