Provider Demographics
NPI:1427284447
Name:OBO INCORPORATED
Entity type:Organization
Organization Name:OBO INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSMANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-552-7099
Mailing Address - Street 1:29350 SOUTHFIELD RD
Mailing Address - Street 2:101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2053
Mailing Address - Country:US
Mailing Address - Phone:248-552-7099
Mailing Address - Fax:
Practice Address - Street 1:29350 SOUTHFIELD RD
Practice Address - Street 2:101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2053
Practice Address - Country:US
Practice Address - Phone:248-552-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center