1235828575 NPI number — MS. MEUMBUR PRAISE KPUGHUR-TULE MD

Table of content: DR. ANDREW S. LIM MD (NPI 1831172162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235828575 NPI number — MS. MEUMBUR PRAISE KPUGHUR-TULE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KPUGHUR-TULE
Provider First Name:
MEUMBUR
Provider Middle Name:
PRAISE
Provider Name Prefix Text:
MS.
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:
1235828575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/07/2023
NPI Reactivation Date:
12/22/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44405 WOODWARD AVE., TRINITY HEALTH OAKLAND
Provider Second Line Business Mailing Address:
GRADUATE MEDICAL EDUCATION DEPT. H-23
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-858-6233
Provider Business Mailing Address Fax Number:
248-858-3244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44405 WOODWARD AVE., TRINITY HEALTH OAKLAND
Provider Second Line Business Practice Location Address:
GRADUATE MEDICAL EDUCATION DEPT. H-23
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-858-6233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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