Provider Demographics
NPI:1205828498
Name:HOBAN, DONNA M (MD)
Entity Type:Individual
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First Name:DONNA
Middle Name:M
Last Name:HOBAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:26901 BEAUMONT BOULEVARD
Mailing Address - Street 2:STE. 3D
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1867
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:22646 E 9 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1951
Practice Address - Country:US
Practice Address - Phone:586-498-4800
Practice Address - Fax:586-498-4830
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-10-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301051777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301110Medicaid
MIE49440Medicare UPIN
MI4301110Medicaid