Individual
DR. ABIMBOLA MODUPE OSOBAMIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
133 S MAIN ST, MOUNT CLEMENS, MI 48043-2308
(586) 468-1600
(586) 465-0329
Mailing address
PO BOX 675398, DETROIT, MI 48267-5398
(586) 329-1880
(586) 231-0055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301063170
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356335418
NPI #
MI
05
—
4846450
—
MI
01
—
70-0-F32947-0
BCBS CPIN #
MI
01
—
AO063170
BCBSM
MI
Enumeration date
09/06/2005
Last updated
07/25/2023
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