Healthcare Provider Details

I. General information

NPI: 1467947408
Provider Name (Legal Business Name): BARAKAT OGUNDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE # H-23
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

44405 WOODWARD AVE # H-23
PONTIAC MI
48341-5023
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-6225
  • Fax:
Mailing address:
  • Phone: 248-858-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301115885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: