Healthcare Provider Details

I. General information

NPI: 1225640030
Provider Name (Legal Business Name): EILEEN M LIMCHOA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 10/07/2024
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 FORT ST
WYANDOTTE MI
48192-3841
US

IV. Provider business mailing address

27555 MIDDLEBELT RD
FARMINGTON HILLS MI
48334
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-9640
  • Fax:
Mailing address:
  • Phone: 248-478-5512
  • Fax: 248-478-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704308058
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: