Healthcare Provider Details

I. General information

NPI: 1093129520
Provider Name (Legal Business Name): BABAFEMI SIJABULISO ONABANJO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10809 MACK AVE
DETROIT MI
48214-2119
US

IV. Provider business mailing address

10809 MACK AVE
DETROIT MI
48214-2119
US

V. Phone/Fax

Practice location:
  • Phone: 313-824-1000
  • Fax: 313-824-9000
Mailing address:
  • Phone: 313-824-1000
  • Fax: 313-824-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301517326
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-01009
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number270329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: