Provider Demographics
NPI:1588820229
Name:FIRST IDEAL ENTERPRISES INC.
Entity Type:Organization
Organization Name:FIRST IDEAL ENTERPRISES INC.
Other - Org Name:IDEAL HOME PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHIYOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-440-0920
Mailing Address - Street 1:29430 MARIMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5237
Mailing Address - Country:US
Mailing Address - Phone:248-440-0920
Mailing Address - Fax:248-440-0292
Practice Address - Street 1:29430 MARIMOOR DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5237
Practice Address - Country:US
Practice Address - Phone:248-440-0920
Practice Address - Fax:248-440-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P02530Medicare PIN