Basic Information
| Provider Information | |||||||||
| NPI: | 1437156064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AWONUGA | ||||||||
| FirstName: | AWONIYI | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE ROAD | ||||||||
| Address2: | SUITE 400-CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485815970 | ||||||||
| FaxNumber: | 2485815640 | ||||||||
| Practice Location | |||||||||
| Address1: | 26400 W 12 MILE RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483528200 | ||||||||
| FaxNumber: | 2483568255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 228734-1 | NY | N | Other Service Providers | Specialist | 207V00000X | 4301089357 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VE0102X | 4301089357 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 02440260 | 05 | NY | MEDICAID |