Dunya Teresa Yaldoo Poltorak, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014136 Issued in MI

Practice address

199 W Brown St
Ste 200
Birmingham, MI 48009-6022

Phone

(248) 203-2333

Fax

(248) 203-2444

NPI assigned

Jan 18, 2007

Last updated

Mar 19, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268956800000",
    "number": "1700939519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 W BROWN ST",
            "address_2": "STE 200",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096022",
            "telephone_number": "248-203-2333",
            "fax_number": "248-203-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 W BROWN ST",
            "address_2": "STE 200",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096022",
            "telephone_number": "248-203-2333",
            "fax_number": "248-203-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLTORAK",
        "first_name": "DUNYA",
        "middle_name": "TERESA YALDOO",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2010-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "5673",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2221910",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Galina Petlakh
• Nhan Thanh Pham, D.O
• Physiostrong LLC
• Eric M. Pihlgren, PH.D.
• Arnold M. Podolsky, M.D.
• Sonia Rachel Pone, MSW, ACSW
• John Porcerelli, PHD
• Sandra L Pourcho, PHD
• Prac Holdings, Inc. (Arcadia Home Care & Staffing)
• Amanda Joy Pratt, D.C

• Clinical Psychologist in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.