Healthcare Provider Details

I. General information

NPI: 1144870296
Provider Name (Legal Business Name): EFTHYMIA ORKOPOULOU ORKOPOULOU BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

404 W FOREST AVE APT 308
YPSILANTI MI
48197-8112
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7705
  • Fax:
Mailing address:
  • Phone: 734-828-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: