Provider Demographics
NPI:1245206044
Name:UMLAUF, MATRIOSCA NATACHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MATRIOSCA
Middle Name:NATACHA
Last Name:UMLAUF
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 1:5 W LANE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1193
Mailing Address - Country:US
Mailing Address - Phone:313-274-3197
Mailing Address - Fax:
Practice Address - Street 1:2331 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3009
Practice Address - Country:US
Practice Address - Phone:313-792-0345
Practice Address - Fax:313-792-0346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066301208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4078422Medicaid
MI4078422Medicaid