Provider Demographics
NPI:1720291339
Name:AWONUGA, MODUPE TEMIDAYO (MBBS)
Entity Type:Individual
Prefix:DR
First Name:MODUPE
Middle Name:TEMIDAYO
Last Name:AWONUGA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:MISS
Other - First Name:MODUPE
Other - Middle Name:TEMIDAYO
Other - Last Name:KUYEBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:SPARROW HOSPITAL - NEONATOLOGY
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2188
Practice Address - Fax:517-364-3994
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0554072080N0001X
MI43010896002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720291339Medicaid