Individual provider Active NPI

Tony Lulgjuraj, M.D.

  • Pediatric Gastroenterology Physician
  • Detroit, MI
National Provider Identifier
1215279880
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
4301109108 Issued in MI
Practice address
Children'S Hospital of Mi
3950 Beaubien 3Rd FL
Detroit, MI 48201
Phone
(313) 745-5585
Fax
(313) 745-5155
NPI assigned
Mar 21, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301109108 MI
Pediatric Gastroenterology Physician 2080P0206X 4301109108 MI Primary

Addresses

Primary practice location

Children'S Hospital of Mi
3950 Beaubien 3Rd FL
Detroit, MI 48201

Mailing address

University Pediatricians
4201 St. Antoine Uhc 5D # 226
Detroit, MI 48201
Phone (313) 966-5051

Other practice location 1

30400 Telegraph Rd Ste 101
Bingham Farms, MI 48025-4538
Phone (248) 642-5437

Other practice location 2

3901 Beaubien St
Carl's Bldg 5th floor - Peds Gastro
Detroit, MI 48201
Phone (313) 745-5585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190411000103 MI Practitioner - Pediatric MedicinePractitioner - Gastroenterology 4688816606 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University Pediatricians Pediatrics CurrentSince Mar 4, 2019 Accepting new patients
University Pediatricians Pediatrics CurrentSince Mar 4, 2019 Accepting new patients
Medical Center Pediatrics PLLC Pediatrics PastSince Mar 27, 2022 Accepting new patients

Locations

3950 Beaubien St
Detroit, MI 48201
Phone (313) 745-5437

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

3901 Beaubien St
Bldg 5TH
Detroit, MI 48201
Phone (313) 745-5585

Interoperability endpoints

  • Direct secure messaging: tlulgjuraj788639@direct.hfhs.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1215279880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY PEDIATRICIANS",
            "address_2": "4201 ST. ANTOINE UHC 5D # 226",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-966-5051",
            "fax_number": "313-966-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHILDREN'S HOSPITAL OF MI",
            "address_2": "3950 BEAUBIEN 3RD FL",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-5585",
            "fax_number": "313-745-5155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30400 Telegraph Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Bingham Farms",
            "state": "MI",
            "postal_code": "480254538",
            "country_code": "US",
            "telephone_number": "248-642-5437",
            "fax_number": "248-642-5456",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3901 Beaubien St",
            "address_2": "Carl's Bldg 5th floor - Peds Gastro",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "48201",
            "country_code": "US",
            "telephone_number": "313-745-5585",
            "fax_number": "313-745-5155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LULGJURAJ",
        "first_name": "TONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-21",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301109108",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MI",
            "license": "4301109108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.