Provider Demographics
NPI:1043548688
Name:MICHIGAN DIZZINESS AND BALANCE CLINIC, INC
Entity Type:Organization
Organization Name:MICHIGAN DIZZINESS AND BALANCE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANU
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:734-246-4900
Mailing Address - Street 1:1848 BIDDLE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3962
Mailing Address - Country:US
Mailing Address - Phone:734-246-4900
Mailing Address - Fax:734-246-4920
Practice Address - Street 1:1848 BIDDLE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3962
Practice Address - Country:US
Practice Address - Phone:734-246-4900
Practice Address - Fax:734-246-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005873225100000X
MI5501007669225100000X
MI5201004451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty