Organization
IDIMO MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN IDEM ETUKO (DIRECTOR)
(651) 639-1400
Entity
Organization
Contact information
Practice address
151 SILVER LAKE RD NW, SUITE 1B, NEW BRIGHTON, MN 55112-3162
(651) 639-1400
(651) 639-1401
Mailing address
151 SILVER LAKE RD NW, SUITE 1B, NEW BRIGHTON, MN 55112-3162
(651) 639-1400
(651) 639-1401
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/02/2006
Last updated
08/22/2020
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