Provider Demographics
NPI:1942036603
Name:NDUBUISI, UCHE THADDEUS
Entity type:Individual
Prefix:
First Name:UCHE
Middle Name:THADDEUS
Last Name:NDUBUISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30116 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2370
Mailing Address - Country:US
Mailing Address - Phone:734-578-7084
Mailing Address - Fax:734-469-2514
Practice Address - Street 1:3927 BURTON ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2717
Practice Address - Country:US
Practice Address - Phone:734-331-9182
Practice Address - Fax:734-469-2514
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide