Individual
BENJAMIN O OSOWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18263 E 10 MILE RD, SUITE E, ROSEVILLE, MI 48066-5805
(586) 552-8696
(586) 552-4404
Mailing address
18263 E 10 MILE RD, SUITE E, ROSEVILLE, MI 48066-5805
(586) 552-8696
(586) 552-4404
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301062528
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053305110
—
MI
01
—
159065
GREAT LAKES HEALTH PLAN
MI
01
—
5493662
AETNA
MI
01
—
609344516
DOL/WORKERS COMP GROUP NUMBER
MI
01
—
700E012740
BCBS GROUP NUMBER
MI
01
—
700E031610
BCBSM GROUP NUMBER
MI
01
—
BO062528
BCBSM
MI
01
—
P00386958
RAILROAD MEDICARE PTAN
MI
Enumeration date
09/06/2005
Last updated
12/03/2013
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