Healthcare Provider Details

I. General information

NPI: 1134702079
Provider Name (Legal Business Name): GIDEON OKARI NYAKUNDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15125 22 MILE RD
SHELBY TOWNSHIP MI
48315-4406
US

IV. Provider business mailing address

15125 22 MILE RD
SHELBY TOWNSHIP MI
48315-4406
US

V. Phone/Fax

Practice location:
  • Phone: 586-532-0599
  • Fax:
Mailing address:
  • Phone: 603-706-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1134702079
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: