REGENTS OF THE UNIVERSITY OF MICHIGAN

Provider Demographics

• NPI: 1225053895
• Name: REGENTS OF THE UNIVERSITY OF MICHIGAN
• Entity Type: Organization
• Organization Name: REGENTS OF THE UNIVERSITY OF MICHIGAN
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: DAVID
• Authorized Official - Middle Name: CHRISTOPHER
• Authorized Official - Last Name: MILLER
• Authorized Official - Phone: 734-936-3568
• Mailing Address - Street 1: 3621 S STATE ST
• Mailing Address - Street 2: PROVIDER ENROLLMENT
• Mailing Address - City: ANN ARBOR
• Mailing Address - State: MI
• Mailing Address - Zip Code: 48108
• Mailing Address - Country: US
• Mailing Address - Phone: 734-647-5299
• Practice Address - Street 1: 8001 CHALLIS RD
• Practice Address - City: BRIGHTON
• Practice Address - State: MI
• Practice Address - Zip Code: 48116
• Practice Address - Country: US
• Practice Address - Phone: 810-227-9510
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-13
• Last Update Date: 2021-05-03

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Multi-Specialty
No	363LC0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Critical Care Medicine	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LG0600X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Gerontology	Group - Multi-Specialty
No	363LN0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Neonatal	Group - Multi-Specialty
No	363LN0005X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Neonatal, Critical Care	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty
No	363LP0222X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics, Critical Care	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty
No	363LP1700X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Perinatal	Group - Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty
No	363LW0102X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Women's Health	Group - Multi-Specialty
No	363LX0001X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Obstetrics & Gynecology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	500D711450	Other	BCBS