Provider Demographics
NPI:1740478270
Name:FIRST IDEAL ENTERPRISES INC.
Entity type:Organization
Organization Name:FIRST IDEAL ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEKUNLE
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:OSHIYOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-440-0920
Mailing Address - Street 1:PO BOX 251062
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1062
Mailing Address - Country:US
Mailing Address - Phone:248-440-0920
Mailing Address - Fax:248-440-0929
Practice Address - Street 1:21700 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 801
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4906
Practice Address - Country:US
Practice Address - Phone:248-440-0920
Practice Address - Fax:248-440-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAO060924208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33532OtherBLUE CROSS BLUE SHIELD
MI0N87210Medicare PIN