Healthcare Provider Details

I. General information

NPI: 1265982466
Provider Name (Legal Business Name): UCHE OBUA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 03/08/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 GREENFIELD RD
SOUTHFIELD MI
48075-5403
US

IV. Provider business mailing address

3498 FOX WOODS CT
WEST BLOOMFIELD MI
48324-3265
US

V. Phone/Fax

Practice location:
  • Phone: 517-914-7788
  • Fax:
Mailing address:
  • Phone: 517-914-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010338
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704277248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: