Provider Demographics
NPI:1760483903
Name:EKOLE, ALPHONSE A (MD)
Entity Type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:A
Last Name:EKOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21331 KELLY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3265
Mailing Address - Country:US
Mailing Address - Phone:586-585-9119
Mailing Address - Fax:586-585-9947
Practice Address - Street 1:21331 KELLY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3265
Practice Address - Country:US
Practice Address - Phone:586-585-9119
Practice Address - Fax:586-585-9947
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301080987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G46288017Medicare ID - Type Unspecified
MII33424Medicare UPIN