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General NPI Number Information
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NPI Number | 1831664499
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Entity Type | Individual
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Provider Name | MRS. UKAMAKA MADELEINE UDEGBUNAM
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Gender | Female
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 4000 ARKONA RD
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City | MILAN
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State | MI
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Zip | 48160-9706
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Country | US
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Telephone | 210-568-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 CRESTVIEW DR
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City | CANTON
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State | MI
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Zip | 48188-2043
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Country | US
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Telephone | 248-229-3987
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704262086
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License Number State | MI
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