Provider Demographics
NPI:1457488009
Name:OBIANWU, EMMANUEL N (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:N
Last Name:OBIANWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14551 SOUTHFIELD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2687
Mailing Address - Country:US
Mailing Address - Phone:313-383-2030
Mailing Address - Fax:313-383-6340
Practice Address - Street 1:14551 SOUTHFIELD RD STE 3
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2687
Practice Address - Country:US
Practice Address - Phone:313-383-2030
Practice Address - Fax:313-383-6340
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033598207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0820899Medicare ID - Type Unspecified
MIB-43757Medicare UPIN