Healthcare Provider Details

I. General information

NPI: 1306428040
Provider Name (Legal Business Name): ESOSA UWAIFO UKPONMWAN MD/MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE # 510
LANSING MI
48912-1896
US

IV. Provider business mailing address

1215 E MICHIGAN AVE # 510
LANSING MI
48912-1896
US

V. Phone/Fax

Practice location:
  • Phone: 281-223-2914
  • Fax:
Mailing address:
  • Phone: 517-364-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351047876
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: