Healthcare Provider Details

I. General information

NPI: 1306537550
Provider Name (Legal Business Name): ANUOLUWA ADEKEMI FASANMI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD,
ROYAL OAK MI
48073
US

IV. Provider business mailing address

3535 W 13 MILE RD,
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax: 248-551-2032
Mailing address:
  • Phone: 248-551-3000
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number435105983
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: