Provider Demographics
NPI:1700549565
Name:DAWODU, EJEMENARE AIMANEHI (MD)
Entity Type:Individual
Prefix:
First Name:EJEMENARE
Middle Name:AIMANEHI
Last Name:DAWODU
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 1:22201 MOROSS RD STE 70
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2166
Mailing Address - Country:US
Mailing Address - Phone:313-343-3800
Mailing Address - Fax:313-343-4756
Practice Address - Street 1:22201 MOROSS RD STE 70
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2166
Practice Address - Country:US
Practice Address - Phone:313-343-3800
Practice Address - Fax:313-343-4756
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351048124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics