=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639496771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID MICHIGAN FERTILITY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2010
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 E MICHIGAN AVE STE 301
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48912-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-254-5772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 953 STROWBRIDGE DR
-----------------------------------------------------
City | HOWELL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48843-6623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. AWONIYI OLUMIDE AWONUGA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 347-254-5772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 4301089357
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------