1316182777 NPI number — DEARBORN MEDICAL ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316182777 NPI number — DEARBORN MEDICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEARBORN MEDICAL ASSOCIATES, P.C.
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:
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:
1316182777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 250704
Provider Second Line Business Mailing Address:
6725 DALY RD.
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48325-0704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-788-7706
Provider Business Mailing Address Fax Number:
248-788-0276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19855 WEST OUTER DR.
Provider Second Line Business Practice Location Address:
SUITE L7
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-277-4929
Provider Business Practice Location Address Fax Number:
313-561-1842
Provider Enumeration Date:
12/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STUDZINSKI
Authorized Official First Name:
URSZULA
Authorized Official Middle Name:
ANNA
Authorized Official Title or Position:
M.D. / OWNER
Authorized Official Telephone Number:
313-277-4929

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  4301062467 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 4301062467 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301062467 , 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: 136372 . This is a "CARE CHOICES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37726 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3355617 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OM13040 . This is a "MEDCARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0824714 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37725 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37726 . This is a "SELECTCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00197310 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 923-1 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G37726 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P10000 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247142 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P10000001 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P10000001 . This is a "MEDICARE BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247142 . This is a "FEDERAL BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 136372 . This is a "CARE CHOICES HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1108247142 . This is a "BLUE CARE NETWORK OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12052 . This is a "CAPE HEALTHPLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DR82155 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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