Provider Demographics
NPI:1437201902
Name:SON - LU HOME CARE DOCTORS PC
Entity Type:Organization
Organization Name:SON - LU HOME CARE DOCTORS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-876-7176
Mailing Address - Street 1:24585 RIDGECROFT
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:586-876-7176
Mailing Address - Fax:586-772-2585
Practice Address - Street 1:24585 RIDGECROFT
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-876-7176
Practice Address - Fax:586-772-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII33424Medicare UPIN