Healthcare Provider Details

I. General information

NPI: 1518989839
Provider Name (Legal Business Name): DAVID M. URBANSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1683 LITTLESTONE RD
GROSSE POINTE WOODS MI
48236-1954
US

IV. Provider business mailing address

110 E STATE ST
EAST TAWAS MI
48730-1328
US

V. Phone/Fax

Practice location:
  • Phone: 313-885-6049
  • Fax: 313-417-2473
Mailing address:
  • Phone: 989-362-8681
  • Fax: 989-362-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301050733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: