Healthcare Provider Details

I. General information

NPI: 1932185923
Provider Name (Legal Business Name): VICTOR INNOCENT OWUSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 HIDDEN MEADOWS DR SUITE 160
HILLSDALE MI
49242-9812
US

IV. Provider business mailing address

451 HIDDEN MEADOWS DR SUITE 160
HILLSDALE MI
49242-9812
US

V. Phone/Fax

Practice location:
  • Phone: 517-439-0056
  • Fax: 517-439-0894
Mailing address:
  • Phone: 517-439-0056
  • Fax: 517-439-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301071371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: