Healthcare Provider Details

I. General information

NPI: 1316182777
Provider Name (Legal Business Name): DEARBORN MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19855 WEST OUTER DR. SUITE L7
DEARBORN MI
48124-2022
US

IV. Provider business mailing address

P.O. BOX 250704 6725 DALY RD.
WEST BLOOMFIELD MI
48325-0704
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-4929
  • Fax: 313-561-1842
Mailing address:
  • Phone: 248-788-7706
  • Fax: 248-788-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301062467
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301062467
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301062467
License Number StateMI

VIII. Authorized Official

Name: DR. URSZULA ANNA STUDZINSKI
Title or Position: M.D. / OWNER
Credential: M.D.
Phone: 313-277-4929