Provider Demographics
NPI:1508066036
Name:LIBERTY EXPRESS CARE, INC.
Entity Type:Organization
Organization Name:LIBERTY EXPRESS CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDOZIE
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:ONONUJU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-752-0706
Mailing Address - Street 1:1320 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4751
Mailing Address - Country:US
Mailing Address - Phone:989-752-0706
Mailing Address - Fax:989-752-0709
Practice Address - Street 1:1104 JANES AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1683
Practice Address - Country:US
Practice Address - Phone:989-752-0263
Practice Address - Fax:989-752-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013295207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01008499OtherHEALTHPLUS
MI700G312590OtherBLUE CROSS BLUE SHIELD
MI5207776Medicaid
MI5207794Medicaid
MI700G312590OtherBLUE CROSS BLUE SHIELD
MI=========OtherCOMMERCIAL
MI5207776Medicaid