1750354692 NPI number — M NATACHA UMLAUF MD PEDIATRICS PLC

Table of content: (NPI 1750354692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750354692 NPI number — M NATACHA UMLAUF MD PEDIATRICS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M NATACHA UMLAUF MD PEDIATRICS PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC ASSOCIATES OF DEARBORN
Provider Other Organization Name Type Code:
3
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:
1750354692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2331 MONROE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-792-0345
Provider Business Mailing Address Fax Number:
313-792-0346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2331 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-792-0345
Provider Business Practice Location Address Fax Number:
313-792-0346
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UMLAUF
Authorized Official First Name:
MATRIOSCA
Authorized Official Middle Name:
NATACHA
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
313-792-0345

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  4301066301 , 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: 4078422 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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