Provider Demographics
NPI:1730260423
Name:EDU, GANIU ABIMBOLA (MD)
Entity type:Individual
Prefix:DR
First Name:GANIU
Middle Name:ABIMBOLA
Last Name:EDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABIMBOLA
Other - Middle Name:GANIU
Other - Last Name:EDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 760421
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-0421
Mailing Address - Country:US
Mailing Address - Phone:313-832-1350
Mailing Address - Fax:
Practice Address - Street 1:2041 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2402
Practice Address - Country:US
Practice Address - Phone:313-551-5501
Practice Address - Fax:313-566-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099612207LP2900X
WIIN PROGRESS207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology