Active NPI
Noel H Upfall, DO
- Family Medicine Physician
- Detroit, MI
National Provider Identifier
1306937305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5100009947
- Practice address
- 1535 East State Fair
Detroit, MI 48203 - Phone
- (313) 891-2740
- Fax
- (313) 891-0775
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5100009947 | MI | Primary |
Addresses
Primary practice location
1535 East State Fair
Detroit, MI 48203
Mailing address
1535 East State Fair
Detroit, MI 48203
Phone (313) 891-2740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1907220 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5100009947 | MI | MD | Family Medicine Physician |
Interoperability endpoints
- nupfall368002@direct.hfhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306937305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1535 EAST STATE FAIR",
"city": "DETROIT",
"state": "MI",
"postal_code": "48203",
"telephone_number": "313-891-2740",
"fax_number": "313-891-0775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1535 EAST STATE FAIR",
"city": "DETROIT",
"state": "MI",
"postal_code": "48203",
"telephone_number": "313-891-2740",
"fax_number": "313-891-0775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UPFALL",
"first_name": "NOEL",
"middle_name": "H",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5100009947",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1907220",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.