Healthcare Provider Details

I. General information

NPI: 1811450844
Provider Name (Legal Business Name): NEIL SAMUEL UMLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 344
MARQUETTE MI
49855-5407
US

IV. Provider business mailing address

45640 SCHOENHERR RD STE B
SHELBY TOWNSHIP MI
48315-6033
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-1325
  • Fax:
Mailing address:
  • Phone: 586-247-4300
  • Fax: 586-532-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMED-PHYS-LIC-161462
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301510950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: