Basic Information
| Provider Information | |||||||||
| NPI: | 1790124931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALLE | ||||||||
| FirstName: | DALIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY PEDIATRICIANS | ||||||||
| Address2: | 4201 ST. ANTOINE - UHC 5D MAILBOX 226 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454405 | ||||||||
| FaxNumber: | 3139660665 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 BEAUBIEN ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138329220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301103335 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0205X | 4301117359 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.