Provider Demographics
NPI:1639496771
Name:MID MICHIGAN FERTILITY CARE
Entity Type:Organization
Organization Name:MID MICHIGAN FERTILITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AWONIYI
Authorized Official - Middle Name:OLUMIDE
Authorized Official - Last Name:AWONUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-254-5772
Mailing Address - Street 1:953 STROWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1322 E MICHIGAN AVE STE 301
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2109
Practice Address - Country:US
Practice Address - Phone:347-254-5772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089357261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2683 NIMedicaid
NY2683 NIMedicaid