Provider Demographics
NPI:1124712609
Name:UBAH, CYNTHIA I (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:I
Last Name:UBAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 JULIUS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5126
Mailing Address - Country:US
Mailing Address - Phone:734-881-2688
Mailing Address - Fax:734-468-8834
Practice Address - Street 1:4625 JULIUS BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5126
Practice Address - Country:US
Practice Address - Phone:734-881-2688
Practice Address - Fax:734-468-8834
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820414226251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health