Healthcare Provider Details

I. General information

NPI: 1003170564
Provider Name (Legal Business Name): NORIMITSU KUWABARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S SPECIALTY CENTER 3950 BEAUBIEN
DETROIT MI
48201
US

IV. Provider business mailing address

UNIVERSITY PEDIATRICIANS 4201 ST. ANTOINE - UHC 5D MAILBOX 226
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5906
  • Fax: 313-745-0955
Mailing address:
  • Phone: 313-745-4405
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301119020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: