Healthcare Provider Details

I. General information

NPI: 1437763406
Provider Name (Legal Business Name): KELECHI AKUBUKWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43000 W 9 MILE RD STE 109
NOVI MI
48375-4180
US

IV. Provider business mailing address

43000 W 9 MILE RD STE 109
NOVI MI
48375-4180
US

V. Phone/Fax

Practice location:
  • Phone: 248-516-4851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704325522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: