Israel Agodu
Individual provider Active NPI Contractor · Detroit, MI
NPI 1154898146 · NPPES record last updated Oct 27, 2018
Key facts
- NPI
- 1154898146
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 6474 Rosemont Ave
Detroit, MI 48228-4754 - Phone
- (313) 441-5212
- NPI assigned
- Oct 27, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
6474 Rosemont Ave
Detroit, MI 48228-4754
Mailing address
6474 Rosemont Ave
Detroit, MI 48228-4754
Phone (313) 441-5212
Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.