Healthcare Provider Details

I. General information

NPI: 1598386484
Provider Name (Legal Business Name): THOMASTINE WILLIAMSON UREH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17321 TELEGRAPH RD
DETROIT MI
48219-3132
US

IV. Provider business mailing address

3756 18TH ST
DETROIT MI
48229-1344
US

V. Phone/Fax

Practice location:
  • Phone: 313-255-0900
  • Fax: 313-255-3549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: