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General NPI Number Information
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NPI Number | 1588820229
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Entity Type | Organization
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Legal Business Name | FIRST IDEAL ENTERPRISES INC.
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 29430 MARIMOOR DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5237
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Country | US
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Telephone | 248-440-0920
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Fax | 248-440-0292
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Provider Business Mailing Address
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Address Line | 29430 MARIMOOR DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5237
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Country | US
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Telephone | 248-440-0920
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Fax | 248-440-0292
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. IRENE OSHIYOYE
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Credential |
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Telephone | 248-440-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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