Healthcare Provider Details

I. General information

NPI: 1679489231
Provider Name (Legal Business Name): UMELBANIN ALOFI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 RAWSONVILLE RD STE 118
VAN BUREN TOWNSHIP MI
48111-2546
US

IV. Provider business mailing address

1200 NETWORK CENTRE DR
EFFINGHAM IL
62401-4602
US

V. Phone/Fax

Practice location:
  • Phone: 734-290-3850
  • Fax:
Mailing address:
  • Phone: 217-540-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603208
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: