Healthcare Provider Details

I. General information

NPI: 1720006224
Provider Name (Legal Business Name): MICHAEL T OKUMURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10499 N 48TH ST
AUGUSTA MI
49012-9500
US

IV. Provider business mailing address

355 N CENTER RD
SAGINAW MI
48638-5849
US

V. Phone/Fax

Practice location:
  • Phone: 269-282-7700
  • Fax:
Mailing address:
  • Phone: 989-401-8916
  • Fax: 833-200-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301076050
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number4301076050
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301076050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: