Provider Demographics
NPI:1760409593
Name:I & L PROFESSIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:I & L PROFESSIONAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-282-4527
Mailing Address - Street 1:15357 FARMINGTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15357 FARMINGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2847
Practice Address - Country:US
Practice Address - Phone:734-266-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty