Provider Demographics
NPI:1689272833
Name:ONWUEGBUNA, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ONWUEGBUNA
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 1:4337 E GRAND RIVER AVE STE 195
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6583
Mailing Address - Country:US
Mailing Address - Phone:248-361-9944
Mailing Address - Fax:734-961-8144
Practice Address - Street 1:4057 RADCLIFF DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-7236
Practice Address - Country:US
Practice Address - Phone:248-361-9944
Practice Address - Fax:734-961-8144
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor