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General NPI Number Information
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NPI Number | 1437383197
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Entity Type | Individual
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Provider Name | BARBARA D'AGNOLUZZO MOREIRA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 3663 WOODWARD AVE STE 200 WSU DETROIT MEDICAL CENTER
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City | DETROIT
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State | MI
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Zip | 48201-2400
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Country | US
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Telephone | 313-745-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 80 E HANCOCK ST APT 408
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City | DETROIT
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State | MI
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Zip | 48201-1328
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Country | US
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Telephone | 313-529-4695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 4301091483
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License Number State | MI
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