Provider Demographics
NPI:1376638528
Name:MICHIGAN HEADACHE & NEUROLOGICAL INSTITUTE PC
Entity Type:Organization
Organization Name:MICHIGAN HEADACHE & NEUROLOGICAL INSTITUTE PC
Other - Org Name:MICHIGAN HEAD-PAIN & NEUROLOGICAL INSTITUTE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:734-677-6000
Mailing Address - Street 1:3120 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5131
Mailing Address - Country:US
Mailing Address - Phone:734-677-6000
Mailing Address - Fax:734-677-2422
Practice Address - Street 1:3120 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5131
Practice Address - Country:US
Practice Address - Phone:734-677-6000
Practice Address - Fax:734-677-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH16194Medicare PIN
OH16194Medicare ID - Type Unspecified