Organization
GROUP MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OBIOMA S AGOMUOH M.D. (OWNER)
(313) 893-8314
Entity
Organization
Contact information
Practice address
3120 CARPENTER ST, STE 111, HAMTRAMCK, MI 48212-9802
(313) 893-8314
(313) 893-7532
Mailing address
27900 BERKSHIRE DR, SOUTHFIELD, MI 48076-4957
(313) 893-8314
(313) 893-7532
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
4301063912
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
4301063912
MI
208D00000X
General Practice Physician
4301063912
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4149140 10
—
MI
01
—
4301063912
MICHIGAN LIC
MI
Enumeration date
11/01/2006
Last updated
09/26/2008
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