Provider Demographics
NPI: | 1508890468 |
---|---|
Name: | REGENTS OF THE UNIVERSITY OF MICHIGAN |
Entity Type: | Organization |
Organization Name: | REGENTS OF THE UNIVERSITY OF MICHIGAN |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | CHRISTOPHER |
Authorized Official - Last Name: | MILLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 734-936-3568 |
Mailing Address - Street 1: | 3621 S STATE STREET |
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 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1500 E MEDICAL CENTER DR |
Practice Address - Street 2: | |
Practice Address - City: | ANN ARBOR |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48109-5000 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-936-4000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-10 |
Last Update Date: | 2021-05-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Multi-Specialty |
No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Multi-Specialty |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Multi-Specialty |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Multi-Specialty |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | Group - Multi-Specialty |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Multi-Specialty |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | Group - Multi-Specialty |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | Group - Multi-Specialty |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | Group - Multi-Specialty |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | Group - Multi-Specialty |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Multi-Specialty |
No | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | Group - Multi-Specialty |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 220H161010 | Other | BCBS |
MI | 0H16101 | Medicare ID - Type Unspecified |