Provider Demographics
NPI:1467037622
Name:ULTRACARE OBGYN PLLC
Entity Type:Organization
Organization Name:ULTRACARE OBGYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHAFAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-338-9762
Mailing Address - Street 1:8191 N WAYNE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1289
Mailing Address - Country:US
Mailing Address - Phone:734-338-9762
Mailing Address - Fax:734-338-6761
Practice Address - Street 1:8191 N WAYNE RD STE 4
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1289
Practice Address - Country:US
Practice Address - Phone:248-939-8874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty