Provider Demographics
NPI:1174838890
Name:TETE ONIANG'O M.D. PLLC
Entity Type:Organization
Organization Name:TETE ONIANG'O M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TETE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONIANG'O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-397-9085
Mailing Address - Street 1:PO BOX 760395
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-0395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20526 PLYMOUTH RD
Practice Address - Street 2:SUITE E
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1201
Practice Address - Country:US
Practice Address - Phone:313-397-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091134208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty