| Doctor Name: | DR. BRENDA UBOM |
| NPI Number: | 1689840472 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 5101007548 |
| Business Practice Address: | 3001 Miller Rd Dearborn, MI - 481201458 |
| Business Phone Number: | 3133230045 |
| Business Fax Number: | 3138454626 |
| Mailing Address: | 24410 Santa Barbara St, SOUTHFIELD |
| State: | MI |
| Postal Code: | 480756813 |
| Phone Number: | 2485599286 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2008 |
| NPI Last Update Date: | 05/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101007548 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |