Individual
EBELE C ODONWODO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, SUITE A721, GRAND RAPIDS, MI 49503-2560
(616) 391-3139
(616) 391-3044
Mailing address
8438 BRADFORD PEAR DR, MASON, OH 45040-7434
(585) 260-9944
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301097441
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336331891
—
MI
01
—
1417961137
BCBSM - BMH
MI
Enumeration date
08/17/2007
Last updated
09/26/2019
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