Provider Demographics
NPI:1376571000
Name:SCOTT EMUAKPOR, AJOVI B (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:AJOVI
Middle Name:B
Last Name:SCOTT EMUAKPOR
Suffix:
Gender:M
Credentials:MD PHD
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Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 145 - MSU PEDIATRIC SUB-SPECIALTY CLINICS
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-5440
Mailing Address - Fax:517-364-5413
Practice Address - Street 1:804 SERVICE ROAD
Practice Address - Street 2:ROOM B240
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7041
Practice Address - Country:US
Practice Address - Phone:517-355-8998
Practice Address - Fax:517-355-8312
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-05-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301039172208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376571000Medicaid
MIC36092026Medicare PIN
B47299Medicare UPIN