Healthcare Provider Details

I. General information

NPI: 1508699109
Provider Name (Legal Business Name): EKPO SURGICAL ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 COOPER ST
JACKSON MI
49202-3398
US

IV. Provider business mailing address

815 OAKDALE RD
ANN ARBOR MI
48105-1076
US

V. Phone/Fax

Practice location:
  • Phone: 517-998-6574
  • Fax:
Mailing address:
  • Phone: 517-998-6574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY EKPO
Title or Position: OWNER
Credential: DO
Phone: 814-323-3942