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General NPI Number Information
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NPI Number | 1912001314
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Entity Type | Organization
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Legal Business Name | BONIFACE A. TUBIE, M.D.
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 20755 GREENFIELD RD SUITE #203
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5403
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Country | US
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Telephone | 248-395-2206
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Fax | 248-395-0456
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Provider Business Mailing Address
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Address Line | 6915 DOBBS WAY
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3077
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Country | US
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Telephone | 248-592-1518
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Fax | 248-395-0456
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Authorized Official
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Title or Position | PHYSICIAN/ CEO
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Name | DR. BONIFACE ATAKEKOR TUBIE
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Credential | M.D.
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Telephone | 248-395-2206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 43010729901
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 246ZN0300X
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Taxonomy Name | Nephrology Specialist/Technologist
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License Number | 4301072901
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301072901
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License Number State | MI
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