Provider Demographics
NPI:1801107552
Name:ODUEYUNGBO, MERCY ADEOLA (MD,)
Entity type:Individual
Prefix:DR
First Name:MERCY
Middle Name:ADEOLA
Last Name:ODUEYUNGBO
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Gender:F
Credentials:MD,
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Mailing Address - Street 1:540 S LAKESHORE BLVD UNIT 34
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4631
Mailing Address - Country:US
Mailing Address - Phone:906-362-7546
Mailing Address - Fax:413-362-7546
Practice Address - Street 1:1500 SANDPOINT RD
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862
Practice Address - Country:US
Practice Address - Phone:906-362-7546
Practice Address - Fax:413-269-8079
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-10-31
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Provider Licenses
StateLicense IDTaxonomies
MI4301108524207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery