Basic Information
Provider Information
NPI: 1023083425
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUCATMAN
FirstName: BARBARA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26901 BEAUMONT BLVD SUITE 3D
Address2:  
City: SOUTHFIELD
State: MI
PostalCode: 480333849
CountryCode: US
TelephoneNumber: 9475221860
FaxNumber: 9475220307
Practice Location
Address1: 3601 W 13 MILE RD
Address2:  
City: ROYAL OAK
State: MI
PostalCode: 480736712
CountryCode: US
TelephoneNumber: 2488989060
FaxNumber: 2488989054
Other Information
ProviderEnumerationDate: 02/20/2006
LastUpdateDate: 01/17/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZC0500X16938WVN Allopathic & Osteopathic PhysiciansPathologyCytopathology
207ZP0102X16938WVN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
207ZP0102X4301112293MIY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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