Individual
OSAEVBIE WOGHIREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
540 E CANFIELD ST, DETROIT, MI 48201-1928
(313) 745-2101
Mailing address
540 E CANFIELD ST, DETROIT, MI 48201-1928
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
289493
MA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
5151017078
MI
208D00000X
General Practice Physician
289493
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289493
—
MA
Enumeration date
06/11/2021
Last updated
06/24/2024
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