Provider Demographics
NPI:1245278977
Name:AGOMUOH, BRIDGET CHINYERE (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:CHINYERE
Last Name:AGOMUOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:CHINYERE
Other - Last Name:NNEJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:37660 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1924
Mailing Address - Country:US
Mailing Address - Phone:734-326-6333
Mailing Address - Fax:734-326-7105
Practice Address - Street 1:37660 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1924
Practice Address - Country:US
Practice Address - Phone:734-326-6333
Practice Address - Fax:734-326-7105
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076093208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4889170Medicaid