MEDICARE: OSAYI IGBINOBARO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703113517	MI

General Provider Information

NPI Number	:	1790183267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSAYI IGBINOBARO

Provider Business Mailing Address
First Line	:	35700 E MICHIGAN AVE
Second Line	:	APT 607
City	:	WAYNE
State	:	MI
Zip	:	48184-1648
Country	:	US
Telephone Number	:	313-629-7569
Fax Number	:

Provider Business Practice Location Address
First Line	:	35700 E MICHIGAN AVE
Second Line	:	APT 607
City	:	WAYNE
State	:	MI
Zip	:	48184-1648
Country	:	US
Telephone Number	:	313-629-7569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	12/15/2014

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Directions to “ OSAYI IGBINOBARO ” Practice Location

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