Individual provider Active NPI

Imo Patricia Udo-Inyang, MD

  • Family Medicine Physician
  • Southfield, MI
National Provider Identifier
1043709157
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301513316 Issued in MI
Practice address
16250 Northland Dr Ste 207
Southfield, MI 48075-5227
Phone
(313) 543-3100
NPI assigned
May 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301513316 MI Primary

Addresses

Primary practice location

16250 Northland Dr Ste 207
Southfield, MI 48075-5227

Mailing address

16250 Northland Dr Ste 207
Southfield, MI 48075-5227
Phone (313) 543-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250709001295 MI Practitioner - Family Practice 2769996057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301513316MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wings of Angel Home Health Care, LLC PastSince May 10, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1043709157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16250 NORTHLAND DR STE 207",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755227",
            "telephone_number": "313-543-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16250 NORTHLAND DR STE 207",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755227",
            "telephone_number": "313-543-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDO-INYANG",
        "first_name": "IMO",
        "middle_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-03",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301513316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.