Healthcare Provider Details

I. General information

NPI: 1437806692
Provider Name (Legal Business Name): DR URSULA BARGHOUTH DO MHA MSPH CWSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

44240 PRINCETON DR
CLINTON TOWNSHIP MI
48038-1095
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-6350
  • Fax:
Mailing address:
  • Phone: 408-807-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. URSULA BARGHOUTH
Title or Position: PHYSICIAN
Credential: DO, MHA, MSPH, CSWP
Phone: 408-807-4504