Healthcare Provider Details

I. General information

NPI: 1386576080
Provider Name (Legal Business Name): EJIROGHENE TEJERE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E WARWICK DRIVE
ALMA MI
48801
US

IV. Provider business mailing address

330 E WARWICK DRIVE
ALMA MI
48801
US

V. Phone/Fax

Practice location:
  • Phone: 989-629-8140
  • Fax: 989-629-8145
Mailing address:
  • Phone: 989-629-8140
  • Fax: 989-629-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351056487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: