Provider Demographics
NPI:1063513943
Name:NUGA PEDIATRICS LENAWEE, PLLC
Entity type:Organization
Organization Name:NUGA PEDIATRICS LENAWEE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEKOYEJO
Authorized Official - Middle Name:BABAJIDE
Authorized Official - Last Name:ADENUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-265-1981
Mailing Address - Street 1:901 KIMOLE LN
Mailing Address - Street 2:STE B2
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1491
Mailing Address - Country:US
Mailing Address - Phone:517-265-1981
Mailing Address - Fax:517-263-1001
Practice Address - Street 1:901 KIMOLE LN
Practice Address - Street 2:STE B2
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1491
Practice Address - Country:US
Practice Address - Phone:517-265-1981
Practice Address - Fax:517-263-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4843556Medicaid
MI5697OtherHEALTH PLAN OF MICHIGAN
MI0461056OtherBCBS PROVIDER #
MI03774OtherPARAMOUNT HEALTHCARE
MI101149OtherGREAT LAKES HEALTH PLAN
MI4843556Medicaid
=========OtherTAX ID