Provider Demographics
NPI:1477594786
Name:AGUWA, MARGARET IJEOMA (DO)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:IJEOMA
Last Name:AGUWA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A322 W FEE HALL
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824
Mailing Address - Country:US
Mailing Address - Phone:517-353-4497
Mailing Address - Fax:
Practice Address - Street 1:2929 COVENTING COURT
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-371-4971
Practice Address - Fax:517-355-1710
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007024208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4325087Medicaid
MI4325087Medicaid