=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518284413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL C NWOKE M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2010
-----------------------------------------------------
Last Update Date | 05/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16420 E 9 MILE RD
-----------------------------------------------------
City | EASTPOINTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48021-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-777-4203
-----------------------------------------------------
Fax | 586-777-4214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16420 E 9 MILE RD
-----------------------------------------------------
City | EASTPOINTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48021-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-777-4203
-----------------------------------------------------
Fax | 586-777-4214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 4301095865
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------