Healthcare Provider Details

I. General information

NPI: 1821291550
Provider Name (Legal Business Name): JOSHUA ESINWOKE NNANJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 JEWETT RD
MASON MI
48854-8729
US

IV. Provider business mailing address

3801 WINCHELL AVE APT G106
KALAMAZOO MI
49008-2038
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-5405
  • Fax: 517-676-5460
Mailing address:
  • Phone: 319-217-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301091517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: