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NPI Code Detail

MEDICARE: DR. BERNARD ASONGANYI MBEBOH MD

MEDICARE: DR. BERNARD ASONGANYI MBEBOH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantC03163MD
2207R00000XInternal Medicine PhysicianD0099241MD

General Provider Information

NPI Number : 1215999107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNARD ASONGANYI MBEBOH MD
Provider Business Mailing Address
First Line : 3031 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-3046
Country : US
Telephone Number : 313-871-3751
Fax Number :
Provider Business Practice Location Address
First Line : 3031 W GRAND BLVD STE 600
Second Line :
City : DETROIT
State : MI
Zip : 48202-3014
Country : US
Telephone Number : 313-871-3751
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 03/26/2024

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