Provider Demographics
NPI:1932185923
Name:OWUSU, VICTOR INNOCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:INNOCENT
Last Name:OWUSU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:451 HIDDEN MEADOWS DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9812
Mailing Address - Country:US
Mailing Address - Phone:517-439-0056
Mailing Address - Fax:517-439-0894
Practice Address - Street 1:451 HIDDEN MEADOWS DR
Practice Address - Street 2:SUITE 160
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9812
Practice Address - Country:US
Practice Address - Phone:517-439-0056
Practice Address - Fax:517-439-0894
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071371207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3415976Medicaid
MI3415976Medicaid