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General NPI Number Information
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NPI Number | 1780631218
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Entity Type | Organization
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Legal Business Name | CORR MEDICAL SUPPLIES & EQUIPMENT
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Dates
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Enumeration Date | 05/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 17010 WEST WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48228-3566
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Country | US
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Telephone | 313-216-9733
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Fax | 313-216-9734
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Provider Business Mailing Address
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Address Line | PO BOX 28365
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City | DETROIT
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State | MI
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Zip | 48228-0365
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Country | US
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Telephone | 313-216-9733
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Fax | 313-216-9734
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLEMENT FRANCIS EKPENYONG
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Credential |
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Telephone | 313-216-9733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | A
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License Number State | MI
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