Individual
KELLYA ANNISA UBOKUDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
34013380
OH
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
5101021815
MI
208000000X
Pediatrics Physician
5101021815
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2015
Last updated
11/07/2022
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