Healthcare Provider Details

I. General information

NPI: 1427284447
Provider Name (Legal Business Name): OBO INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29350 SOUTHFIELD RD 101
SOUTHFIELD MI
48076-2053
US

IV. Provider business mailing address

29350 SOUTHFIELD RD 101
SOUTHFIELD MI
48076-2053
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-7099
  • Fax:
Mailing address:
  • Phone: 248-552-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OSMANY ODUARDO
Title or Position: PRESIDENT
Credential:
Phone: 248-552-7099