Healthcare Provider Details

I. General information

NPI: 1093393449
Provider Name (Legal Business Name): MARIANA TUMMINELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 2111
YPSILANTI MI
48197-1097
US

IV. Provider business mailing address

5333 MCAULEY DR RM 2111
YPSILANTI MI
48197-1097
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-2563
  • Fax: 734-712-8777
Mailing address:
  • Phone: 734-712-2563
  • Fax: 734-712-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301517700
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: