Healthcare Provider Details

I. General information

NPI: 1164630810
Provider Name (Legal Business Name): EMRE CONKLU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 15 MILE RD
STERLING HEIGHTS MI
48310-5353
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 586-977-9300
  • Fax: 313-876-1305
Mailing address:
  • Phone: 800-999-5829
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101016648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: