Healthcare Provider Details

I. General information

NPI: 1760468490
Provider Name (Legal Business Name): VIOREL C LUPU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23300 ECORSE RD
TAYLOR MI
48180-1768
US

IV. Provider business mailing address

23300 ECORSE RD
TAYLOR MI
48180-1768
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-9500
  • Fax: 313-291-9516
Mailing address:
  • Phone: 313-291-9500
  • Fax: 313-291-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301060555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: