Healthcare Provider Details

I. General information

NPI: 1023016474
Provider Name (Legal Business Name): ARIS QUEROL URBANES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/07/2023
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 917
DETROIT MI
48201-2017
US

IV. Provider business mailing address

1036 BISHOP RD
GROSSE POINTE PARK MI
48230-1448
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4525
  • Fax:
Mailing address:
  • Phone: 313-882-0554
  • Fax: 313-640-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301057086
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: