Healthcare Provider Details

I. General information

NPI: 1225734296
Provider Name (Legal Business Name): AKUNNA AGUWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KIRTS BLVD STE 100
TROY MI
48084-4135
US

IV. Provider business mailing address

PO BOX 639295
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-0500
  • Fax:
Mailing address:
  • Phone: 248-824-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704354110
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: