Healthcare Provider Details

I. General information

NPI: 1750354692
Provider Name (Legal Business Name): M NATACHA UMLAUF MD PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 MONROE ST
DEARBORN MI
48124
US

IV. Provider business mailing address

2331 MONROE ST
DEARBORN MI
48124
US

V. Phone/Fax

Practice location:
  • Phone: 313-792-0345
  • Fax: 313-792-0346
Mailing address:
  • Phone: 313-792-0345
  • Fax: 313-792-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301066301
License Number StateMI

VIII. Authorized Official

Name: MATRIOSCA NATACHA UMLAUF
Title or Position: PHYSICIAN
Credential: MD
Phone: 313-792-0345