Organization
NEPHROLOGY & INTENSIVE CARE ASSOC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMOKAYODE ADEBISI OSOBAMIRO M.D. (OWNER)
(586) 228-7433
Entity
Organization
Contact information
Practice address
16151 19 MILE RD, SUITE 301, CLINTON TOWNSHIP, MI 48038-1158
(586) 228-7433
(586) 412-3924
Mailing address
PO BOX 82057, ROCHESTER, MI 48308-2057
(248) 969-3220
(248) 274-5059
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301059326
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
4301059326
MI
207RN0300X
Nephrology Physician
4301059326
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10 4841551
—
MI
01
—
1105018352
BCBSM
MI
Enumeration date
06/08/2006
Last updated
04/10/2024
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