Provider Demographics
NPI:1316182777
Name:DEARBORN MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DEARBORN MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:URSZULA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:STUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-277-4929
Mailing Address - Street 1:P.O. BOX 250704
Mailing Address - Street 2:6725 DALY RD.
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0704
Mailing Address - Country:US
Mailing Address - Phone:248-788-7706
Mailing Address - Fax:248-788-0276
Practice Address - Street 1:19855 WEST OUTER DR.
Practice Address - Street 2:SUITE L7
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2022
Practice Address - Country:US
Practice Address - Phone:313-277-4929
Practice Address - Fax:313-561-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062467207R00000X, 207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI136372OtherCARE CHOICES HEALTH PLAN
MIG37726OtherPPOM
MI3355617Medicaid
MIOM13040OtherMEDCARE ID-TYPE UNSPECIFIED
MI0824714OtherBCBSM
MIG37725OtherPRIORITY HEALTH
MIG37726OtherSELECTCARE
MIP00197310OtherRAILROAD MEDICARE
MI923-1OtherTOTAL HEALTH CARE
MIG37726OtherHAP
MI0P10000OtherMEDICARE ID-TYPE UNSPECIFIED
MI1108247142OtherBLUE CROSS BLUE SHIELD
MI0P10000001OtherMEDICARE
MI0P10000001OtherMEDICARE BLUE CROSS
MI1108247142OtherFEDERAL BLUE CROSS BLUE SHIELD
MI136372OtherCARE CHOICES HMO
MI1108247142OtherBLUE CARE NETWORK OF MICHIGAN
MI12052OtherCAPE HEALTHPLAN
MIDR82155OtherMCARE
MIG37726OtherSELECTCARE
MIG37726OtherPPOM
MI1108247142OtherBLUE CARE NETWORK OF MICHIGAN