Healthcare Provider Details

I. General information

NPI: 1316513765
Provider Name (Legal Business Name): CYNTHIA OGHENEKOME OKARUEFE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN BLVD
DETROIT MI
48201
US

IV. Provider business mailing address

4201, ST. ANTOINE UHC 9C
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5437
  • Fax: 313-993-7118
Mailing address:
  • Phone: 313-745-6047
  • Fax: 313-966-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351048468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: