Healthcare Provider Details

I. General information

NPI: 1053102517
Provider Name (Legal Business Name): MICHAEL ANEGBODE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 REISTERSTOWN RD STE 350
PIKESVILLE MD
21208-7126
US

IV. Provider business mailing address

1829 REISTERSTOWN RD STE 350
PIKESVILLE MD
21208-7126
US

V. Phone/Fax

Practice location:
  • Phone: 443-518-8190
  • Fax:
Mailing address:
  • Phone: 443-518-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberRSA-02823
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: