Healthcare Provider Details

I. General information

NPI: 1497119689
Provider Name (Legal Business Name): SOUTH EASTERN MICHIGAN COLON & RECTAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 S WAYNE RD
WAYNE MI
48184-1221
US

IV. Provider business mailing address

3106 S WAYNE RD
WAYNE MI
48184-1221
US

V. Phone/Fax

Practice location:
  • Phone: 734-722-1063
  • Fax: 734-722-4815
Mailing address:
  • Phone: 734-722-1063
  • Fax: 734-722-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEWUNMI ADEYEMO
Title or Position: OWNER
Credential: DO
Phone: 743-722-6300