Provider Demographics
NPI:1568167757
Name:OGEDGEBE, OBOSEH JOHN
Entity Type:Individual
Prefix:
First Name:OBOSEH
Middle Name:JOHN
Last Name:OGEDGEBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DRIVE, ACADEMIC INTERNAL MEDICINE CLINIC
Mailing Address - Street 2:SUITE 4001 YPSILANTI
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8633
Mailing Address - Country:US
Mailing Address - Phone:734-712-3980
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DRIVE, ACADEMIC INTERNAL MEDICINE CLINIC
Practice Address - Street 2:SUITE 4001 YPSILANTI
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program