Healthcare Provider Details

I. General information

NPI: 1407207889
Provider Name (Legal Business Name): FATIMA NOORULLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 07/15/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E. HOSPITAL DR. LEVEL 6, RECEPTION C
ANN ARBOR MI
48109
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-9777
  • Fax: 734-936-6897
Mailing address:
  • Phone: 734-936-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301109698
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number4301510834
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: