Healthcare Provider Details

I. General information

NPI: 1093319899
Provider Name (Legal Business Name): FRANCIS OGUNEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 CLARK ST
JACKSON MI
49202-1610
US

IV. Provider business mailing address

2726 CLARK ST
JACKSON MI
49202-1610
US

V. Phone/Fax

Practice location:
  • Phone: 517-414-6615
  • Fax:
Mailing address:
  • Phone: 517-414-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: