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General NPI Number Information
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NPI Number | 1760301444
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Entity Type | Individual
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Provider Name | EMMANUEL UCHENNA AGBO MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 205 N EAST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1753
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Country | US
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Telephone | 810-931-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N JACKSON ST
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City | JACKSON
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State | MI
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Zip | 49201-1204
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Country | US
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Telephone |
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Fax |
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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 | 4351056242
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License Number State | MI
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