Provider Demographics
NPI:1528368651
Name:NOEL UPFALL D.O. P.C.
Entity Type:Organization
Organization Name:NOEL UPFALL D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UPFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-891-2740
Mailing Address - Street 1:1535 EAST STATE FAIR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203
Mailing Address - Country:US
Mailing Address - Phone:313-891-2740
Mailing Address - Fax:313-891-0775
Practice Address - Street 1:1535 EAST STATE FAIR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203
Practice Address - Country:US
Practice Address - Phone:313-891-2740
Practice Address - Fax:313-891-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care