1093725186 NPI number — USHA L DOSHI MD

Table of content: USHA L DOSHI MD (NPI 1093725186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093725186 NPI number — USHA L DOSHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSHI
Provider First Name:
USHA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093725186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48203-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-925-4540
Provider Business Mailing Address Fax Number:
313-925-0322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3956 MOUNT ELLIOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48207-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-925-4540
Provider Business Practice Location Address Fax Number:
313-925-0322
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301040412 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104412119 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104412137 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104412128 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700H248710 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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