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General NPI Number Information
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NPI Number | 1194618694
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Entity Type | Individual
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Provider Name | MR. COURAGE OSAMUDIAMEN IDAHOR
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 16001 W. NINE MILE ROAD SOUTHFIELD MI 48075 HENRY FORD
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-849-5664
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Fax | 248-849-5323
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Provider Business Mailing Address
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Address Line | 16001 W. NINE MILE ROAD SOUTHFIELD MI 48075 HENRY FORD
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-849-3015
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Fax | 248-869-2578
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4351054178
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License Number State | MI
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