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General NPI Number Information
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NPI Number | 1023075744
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Entity Type | Organization
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Legal Business Name | PRIME MEDICAL HEALTH CARE PC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 16184 E 10 MILE RD STE 101
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City | EASTPOINTE
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State | MI
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Zip | 48021
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Country | US
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Telephone | 586-779-4550
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Fax | 586-779-4551
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Provider Business Mailing Address
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Address Line | 1948 HARLEY CT
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City | ANN ARBOR
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State | MI
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Zip | 48103-8980
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Country | US
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Telephone | 734-276-7239
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NWANNEKA UCHENNA ODUMODU
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Credential | M.D.
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Telephone | 734-276-7239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0776377
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License Number State | MI
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