Provider Demographics
NPI:1700268547
Name:CAXTON-IDOWU, SIMISOLA MARIE (MD)
Entity type:Individual
Prefix:
First Name:SIMISOLA
Middle Name:MARIE
Last Name:CAXTON-IDOWU
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 1:22250 PROVIDENCE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6211
Mailing Address - Country:US
Mailing Address - Phone:248-465-4470
Mailing Address - Fax:248-465-4471
Practice Address - Street 1:22250 PROVIDENCE DR STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6211
Practice Address - Country:US
Practice Address - Phone:248-465-4470
Practice Address - Fax:248-465-4471
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108348207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology