Provider Demographics
NPI:1043281272
Name:ULINFUN, THEOPHILUS OSAYI (DO)
Entity type:Individual
Prefix:DR
First Name:THEOPHILUS
Middle Name:OSAYI
Last Name:ULINFUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2610
Mailing Address - Country:US
Mailing Address - Phone:313-388-1400
Mailing Address - Fax:
Practice Address - Street 1:752 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2610
Practice Address - Country:US
Practice Address - Phone:313-388-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITU010840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM93840Medicare PIN
MIF42243Medicare UPIN