Provider Demographics
NPI:1184655847
Name:ESONET MEDICAL EQUIPMENT & MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:ESONET MEDICAL EQUIPMENT & MEDICAL SUPPLIES, INC.
Other - Org Name:ESONET MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:OKPAKO
Authorized Official - Last Name:EGHWOFOBE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMEPOS PROVIDER
Authorized Official - Phone:248-423-1243
Mailing Address - Street 1:19111 W 10 MILE RD STE 232
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2472
Mailing Address - Country:US
Mailing Address - Phone:248-423-1243
Mailing Address - Fax:248-423-1244
Practice Address - Street 1:19111 W 10 MILE RD STE 232
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2472
Practice Address - Country:US
Practice Address - Phone:248-423-1243
Practice Address - Fax:248-423-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBCBS: 540F329810OtherDURABLE MEDICAL EQUIPMENT
MI4820060Medicaid
MI4820060Medicaid
MI5562120001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT