Provider Demographics
NPI:1134457435
Name:BIO ENERGY MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:BIO ENERGY MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEUENSCHWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-995-3200
Mailing Address - Street 1:3131 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5128
Mailing Address - Country:US
Mailing Address - Phone:734-995-3200
Mailing Address - Fax:734-995-4254
Practice Address - Street 1:3131 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5128
Practice Address - Country:US
Practice Address - Phone:734-995-3200
Practice Address - Fax:734-995-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050438207Q00000X, 207Q00000X
MI4301091374207Q00000X
MI4704136630363LA2200X
MI4704196627363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB48421Medicare UPIN