Healthcare Provider Details

I. General information

NPI: 1043281272
Provider Name (Legal Business Name): THEOPHILUS OSAYI ULINFUN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 SOUTHFIELD RD
LINCOLN PARK MI
48146-2610
US

IV. Provider business mailing address

752 SOUTHFIELD RD
LINCOLN PARK MI
48146-2610
US

V. Phone/Fax

Practice location:
  • Phone: 313-388-1400
  • Fax:
Mailing address:
  • Phone: 313-388-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTU010840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: