Provider Demographics
NPI:1326417494
Name:PILGRIM, ONIA LEE
Entity type:Individual
Prefix:MS
First Name:ONIA
Middle Name:LEE
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ONIA
Other - Middle Name:LEE
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2263 EDISON STREET
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2042
Mailing Address - Country:US
Mailing Address - Phone:313-492-7999
Mailing Address - Fax:
Practice Address - Street 1:2263 EDISON STREET
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2042
Practice Address - Country:US
Practice Address - Phone:313-492-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326417494Medicaid