Provider Demographics
NPI:1023118189
Name:LUPU, MIHAELA A (MD)
Entity type:Individual
Prefix:
First Name:MIHAELA
Middle Name:A
Last Name:LUPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 ECORSE ROAD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1768
Mailing Address - Country:US
Mailing Address - Phone:313-291-9500
Mailing Address - Fax:313-291-6694
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:STE 208
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-271-5670
Practice Address - Fax:313-271-1053
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIML068630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H248450OtherBCBS MI
MI4081722Medicaid
MI4081722-10Medicaid
MI0M82540018Medicare PIN
MIG95215Medicare UPIN
MI4081722Medicaid