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General NPI Number Information
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NPI Number | 1740478270
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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 | 10/10/2007
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 21700 NORTHWESTERN HWY SUITE 801
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4906
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Country | US
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Telephone | 248-440-0920
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Fax | 248-440-0929
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Provider Business Mailing Address
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Address Line | PO BOX 251062
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City | W BLOOMFIELD
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State | MI
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Zip | 48325-1062
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Country | US
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Telephone | 248-440-0920
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Fax | 248-440-0929
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Authorized Official
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Title or Position | CEO
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Name | DR. ADEKUNLE EMMANUEL OSHIYOYE
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Credential | M.D.
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | AO060924
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License Number State | MI
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