Provider Demographics
NPI:1437156064
Name:AWONUGA, AWONIYI O (MD)
Entity Type:Individual
Prefix:DR
First Name:AWONIYI
Middle Name:O
Last Name:AWONUGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE ROAD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5970
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:26400 W 12 MILE RD
Practice Address - Street 2:STE 140
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1753
Practice Address - Country:US
Practice Address - Phone:248-352-8200
Practice Address - Fax:248-356-8255
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY228734-1174400000X
MI4301089357207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02440260Medicaid
MI0P30630709Medicare PIN
NY2683N1Medicare ID - Type Unspecified
NY02440260Medicaid