Provider Demographics
NPI:1376095273
Name:UNIVERSITY OF DETROIT MERCY
Entity Type:Organization
Organization Name:UNIVERSITY OF DETROIT MERCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT OF ORTHODONTICS CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KULBERSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-494-6731
Mailing Address - Street 1:2440 PARMENTER BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-1339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 PARMENTER BLVD APT 201
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1339
Practice Address - Country:US
Practice Address - Phone:415-754-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization