Individual
MRS. ETHEL MBOMBOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
21409 KELLY RD, SUITE 400, EASTPOINTE, MI 48021-3264
(586) 777-0630
(586) 777-0631
Mailing address
4967 CROOKS RD, STE 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-1614
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1088784
MI
207R00000X
Internal Medicine Physician
5601005700
MI
363A00000X
Physician Assistant
Primary
5601005700
MI
Other
Enumeration date
10/15/2009
Last updated
07/29/2015
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