RONALDO B SUPENA (NPI# 1275576886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275576886 |
| Entity Type | Individual |
| Full Name | RONALDO B SUPENA |
| Credential | MD |
| Practice Address |
611 Martin Luther King Jr Blvd Detroit MI 48201-2273 |
| Mailing Address |
611 Martin Luther King Jr Blvd Suite 702 Detroit MI 48201-2273 |
| Practice Telephone | 3138326300 |
| Practice Fax Number | 3138322075 |
| Mailing Telephone | 3138326300 |
| Mailing Fax Number | 3138328341 |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-06-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Street Address |
611 MARTIN LUTHER KING JR BLVD |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2273 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750732830 | Detroit Community Health Connection | Community/Behavioral Health | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2016-06-29 |
| 1588905830 | Gwen Lee | Registered Nurse | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2013-03-12 |
| 1295073773 | Lavetta Annette Pickens | Nurse Practitioner | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2013-01-18 |
| 1215200399 | Detroit Community Health Connection, Inc. | Clinic/Center | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2012-02-20 |
| 1841445640 | Norris Carnell Polk | Pediatrics | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2008-11-20 |
| 1851547038 | Marie Shoulders-williams | Nurse Practitioner | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2008-08-07 |
| 1790948982 | Detroit Community Health Connection, Inc | Clinic/Center | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2008-07-08 |
| 1427084128 | Mayra Troya-nutt | Obstetrics & Gynecology | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2006-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
| Find all providers in zip 48201 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679195721 | Family Medical Center of Michigan,inc | Clinic/Center | 2740 Collingwood St Ste 100, Detroit, MI 48206-1473 | 2020-05-12 |
| 1154892958 | Family Medical Center of Michigan, Inc | Clinic/Center | 2425 Tuxedo St Rm 115, Detroit, MI 48206-1222 | 2018-12-06 |
| 1801361464 | Detroit Health Care for The Homeless | Clinic/Center | 1355 Oakman Blvd, Detroit, MI 48238-2849 | 2018-10-10 |
| 1306329800 | Family Medical Center of Michigan,inc | Clinic/Center | 15531 Linwood St Rm 102, Detroit, MI 48238-1465 | 2018-09-11 |
| 1982072963 | Detroit Healthcare for The Homeless | Clinic/Center | 1234 Porter St, Detroit, MI 48226-2407 | 2015-09-09 |
| 1851554034 | Detroit Community Health Connection, Inc | Clinic/Center | 111 W 7 Mile Rd, Detroit, MI 48203-1968 | 2008-07-08 |
| 1396839981 | Detroit Health Care for The Homeless | Clinic/Center | 60 E. Warren, Detroit, MI 48201 | 2006-10-03 |
| 1285735845 | Detroit Health Care for The Homeless | Clinic/Center | 20548 Fenkell, Detroit, MI 48223 | 2006-09-26 |
| 1033109244 | Community Health and Social Services Center, Inc | Clinic/Center | 7436 Woodward Ave, Detroit, MI 48202-3100 | 2005-10-27 |
| 1588137376 | Detroit Community Health Connection, Inc | Clinic/Center | 20303 Kelly Rd, Detroit, MI 48225-1206 | 2019-01-04 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.