Healthcare Provider Details

I. General information

NPI: 1457488009
Provider Name (Legal Business Name): EMMANUEL N OBIANWU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 SOUTHFIELD RD STE 3
ALLEN PARK MI
48101-2687
US

IV. Provider business mailing address

14551 SOUTHFIELD RD STE 3
ALLEN PARK MI
48101-2687
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-2030
  • Fax: 313-383-6340
Mailing address:
  • Phone: 313-383-2030
  • Fax: 313-383-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301033598
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: