MEDICARE: DONNA PRINCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	43010061890	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43010061890	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1235132069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA PRINCE M.D.

Provider Business Mailing Address
First Line	:	2799 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2608
Country	:	US
Telephone Number	:	313-640-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2799 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2608
Country	:	US
Telephone Number	:	313-640-2341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/20/2012

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Directions to “ DONNA PRINCE M.D.” Practice Location

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