Provider Demographics
NPI:1164482451
Name:MANUEL DUMLAO MD PC
Entity Type:Organization
Organization Name:MANUEL DUMLAO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUMLAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-562-6633
Mailing Address - Street 1:2314 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3045
Mailing Address - Country:US
Mailing Address - Phone:313-562-6633
Mailing Address - Fax:313-562-0880
Practice Address - Street 1:2314 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3045
Practice Address - Country:US
Practice Address - Phone:313-562-6633
Practice Address - Fax:313-562-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047459261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2608218572OtherBLUE CROSS BLUE SHIELD
MI2608218572OtherBLUE CROSS BLUE SHIELD
MI0821857Medicare ID - Type Unspecified