Provider Demographics
NPI:1437806692
Name:DR URSULA BARGHOUTH DO MHA MSPH CWSP
Entity Type:Organization
Organization Name:DR URSULA BARGHOUTH DO MHA MSPH CWSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGHOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MHA, MSPH, CSWP
Authorized Official - Phone:408-807-4504
Mailing Address - Street 1:44240 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1095
Mailing Address - Country:US
Mailing Address - Phone:408-807-4504
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-849-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center