Individual
BOSE OGBEIFUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15565 NORTHLAND DR W, SOUTHFIELD, MI 48075-5303
(313) 213-6723
Mailing address
15565 NORTHLAND DR W, SOUTHFIELD, MI 48075-5303
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
04/13/2017
Last updated
04/13/2017
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