Healthcare Provider Details

I. General information

NPI: 1477594786
Provider Name (Legal Business Name): MARGARET IJEOMA AGUWA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COVENTING COURT
LANSING MI
48912
US

IV. Provider business mailing address

A322 W FEE HALL
EAST LANSING MI
48824
US

V. Phone/Fax

Practice location:
  • Phone: 517-371-4971
  • Fax: 517-355-1710
Mailing address:
  • Phone: 517-353-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101007024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: