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General NPI Number Information
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NPI Number | 1730324096
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Entity Type | Individual
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Provider Name | LYDIA JOY DONOGHUE MD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST DEPT OF PEDIATRIC SURGERY
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-831-3220
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Fax | 313-745-0747
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Provider Business Mailing Address
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Address Line | 8234 JOHN R
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City | DETROIT
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State | MI
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Zip | 48202-2506
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Country | US
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Telephone | 248-219-5620
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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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 35095454
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 4301077977
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License Number State | MI
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