Provider Demographics
NPI:1245757756
Name:ORGAN PROCUREMENT AGENCY OF MICHIGAN
Entity Type:Organization
Organization Name:ORGAN PROCUREMENT AGENCY OF MICHIGAN
Other - Org Name:GIFT OF LIFE MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LADORA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-922-1094
Mailing Address - Street 1:3861 RESEARCH PARK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2217
Mailing Address - Country:US
Mailing Address - Phone:734-922-1052
Mailing Address - Fax:
Practice Address - Street 1:3861 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2217
Practice Address - Country:US
Practice Address - Phone:734-922-1052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335U00000XSuppliersOrgan Procurement Organization