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General NPI Number Information
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NPI Number | 1871741694
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Entity Type | Individual
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Provider Name | MARTIN UGOCHUKWU EGENTI MD
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Gender | Male
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 826 W KING ST
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City | OWOSSO
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State | MI
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Zip | 48867-2120
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Country | US
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Telephone | 899-723-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 4842 WASHTENAW AVENUE APT C1
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 202-487-7419
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0116020489
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301101807
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License Number State | MI
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