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General NPI Number Information
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NPI Number | 1023118809
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Entity Type | Individual
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Provider Name | OBIOMA S AGOMUOH M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 3120 CARPENTER ST SUITE 111
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City | HAMTRAMCK
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State | MI
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Zip | 48212-9802
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Country | US
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Telephone | 313-893-8314
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Fax | 313-893-7532
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Provider Business Mailing Address
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Address Line | 27900 BERKSHIRE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48076-4957
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Country | US
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Telephone | 313-893-8314
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Fax | 313-893-7532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4030063912
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 4030063912
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License Number State | MI
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