Provider Demographics
NPI:1629162516
Name:UKO EKAIKO
Entity Type:Organization
Organization Name:UKO EKAIKO
Other - Org Name:FREEDOM MEDICAL EQUIPMENT &SUPPLY
Other - Org Type:Other Name
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:UKO
Authorized Official - Middle Name:T
Authorized Official - Last Name:EKAIKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-356-7884
Mailing Address - Street 1:19111 WEST TEN MILE ROAD
Mailing Address - Street 2:SUITE A8
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-356-7884
Mailing Address - Fax:248-356-1067
Practice Address - Street 1:19111 WEST TEN MILE ROAD
Practice Address - Street 2:SUITE A8
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-356-7884
Practice Address - Fax:248-356-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4458038332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540F300740OtherBLUE CROSS BLUE SHIELD
MI4458038Medicaid
MI4458038Medicaid
4630210001Medicare NSC