Individual
ENRIQUE URDANIVIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4700 SCHAEFER RD, DEARBORN, MI 48126-3698
(313) 581-2600
(313) 581-0228
Mailing address
3234 MONTMARTE CIR, W BLOOMFIELD, MI 48323-3541
(248) 737-8043
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301037751
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001007
MIDWEST HEALTH PLAN
MI
05
—
101379155
—
MI
01
—
110Q262840
BCBSM/BCN
MI
01
—
123355
GREAT LAKES HEALTH PLAN
MI
01
—
236661
MEDICARE PROVIDER NO
MI
01
—
4558034
AETNA
MI
01
—
50805
OMNICARE HEALTH PLAN
MI
01
—
B42918
HEALTH ALLIANCE PLAN
MI
Enumeration date
05/11/2006
Last updated
03/05/2012
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