Healthcare Provider Details

I. General information

NPI: 1871023036
Provider Name (Legal Business Name): FIDEL CHIDI OKOYE RESPIRATORYTHERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: N/A N/A N/A RESPIRATORYTHERAPIST

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 TIMBERRIDGE DR
WEST BLOOMFIELD MI
48324-1475
US

IV. Provider business mailing address

5743 TIMBERRIDGE DR
WEST BLOOMFIELD MI
48324-1475
US

V. Phone/Fax

Practice location:
  • Phone: 248-376-9014
  • Fax: 313-766-7957
Mailing address:
  • Phone: 248-376-9014
  • Fax: 313-766-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278E0002X
TaxonomyEmergency Care Certified Respiratory Therapist
License Number14150
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: