Provider Demographics
NPI:1972586592
Name:ONUIGBO, MAUREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:ONUIGBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:2725 AIRVIEW BLVD
Practice Address - Street 2:STE 105
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1803
Practice Address - Country:US
Practice Address - Phone:269-349-8386
Practice Address - Fax:269-349-8397
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35133459207R00000X
MI4301078716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4796474Medicaid
MIF37432145Medicare ID - Type Unspecified001 FEE LOCALITY
MII33741Medicare UPIN
MIM40150108Medicare ID - Type Unspecified99 FEE LOCALITY