Provider Demographics
NPI:1740230085
Name:YOUNG, ESTHER LAURA (DO)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:LAURA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29992 NORTHWESTERN HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5182
Practice Address - Street 1:633 SOUTH BLVD E STE 1300
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5364
Practice Address - Country:US
Practice Address - Phone:248-299-0000
Practice Address - Fax:248-299-6885
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010150962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740230085Medicaid
MIMI4989176OtherMEDICARE PTAN
MI1356313514OtherBCBSM INDIVIDUAL
MII43669Medicare UPIN
MI0M92440068Medicare PIN