Healthcare Provider Details

I. General information

NPI: 1649284761
Provider Name (Legal Business Name): JOSEPHINE Z KASA-VUBU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR 8TH FLOOR C.S. MOTT CHILDRENS HOSPITAL
ANN ARBOR MI
48109-4259
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE ATTN ELLEN KAYFES
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4185
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301406646
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number4301406646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: