Provider Demographics
NPI:1760468490
Name:LUPU, VIOREL C (MD)
Entity Type:Individual
Prefix:DR
First Name:VIOREL
Middle Name:C
Last Name:LUPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1768
Mailing Address - Country:US
Mailing Address - Phone:313-291-9500
Mailing Address - Fax:313-291-9516
Practice Address - Street 1:23300 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1768
Practice Address - Country:US
Practice Address - Phone:313-291-9500
Practice Address - Fax:313-291-9516
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124981OtherCARE-PREFERRED CHOICES
MI1760468490Medicaid
MIC4040OtherM'CARE
MI110218753OtherRR MEDICARE
MI700H222490OtherBLUE SHIELD
MIG29670Medicare UPIN
MI0N97850011Medicare PIN