Provider Demographics
NPI:1255540183
Name:FAVOR MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:FAVOR MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EKPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-273-5759
Mailing Address - Street 1:15730 WEST SEVEN MILE ROAD
Mailing Address - Street 2:FAVOR MEDICAL SUPPLIES LLC
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-273-5759
Mailing Address - Fax:313-273-3022
Practice Address - Street 1:15730 WEST SEVEN MILE ROAD
Practice Address - Street 2:FAVOR MEDICAL SUPPLIES LLC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-273-5759
Practice Address - Fax:313-273-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-52160200Medicaid
MI87-52160200Medicaid