Healthcare Provider Details

I. General information

NPI: 1801419635
Provider Name (Legal Business Name): GABRIELLE ADANNA OGU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22170 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

IV. Provider business mailing address

23131 SUTTON DR
SOUTHFIELD MI
48033-3310
US

V. Phone/Fax

Practice location:
  • Phone: 248-372-6800
  • Fax:
Mailing address:
  • Phone: 248-252-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: