Provider Demographics
NPI:1528136066
Name:DUCU, MIRELLA F (MD)
Entity type:Individual
Prefix:
First Name:MIRELLA
Middle Name:F
Last Name:DUCU
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 1:3407 BUCKINGHAM TRL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2811
Mailing Address - Country:US
Mailing Address - Phone:248-842-9871
Mailing Address - Fax:
Practice Address - Street 1:3407 BUCKINGHAM TRL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2811
Practice Address - Country:US
Practice Address - Phone:248-842-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine