Provider Demographics
NPI: | 1790719532 |
---|---|
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 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 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 325 EAST EISENHOWER PKWY |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | ANN ARBOR |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48108 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-936-7175 |
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 | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081H0002X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine | Group - Multi-Specialty |
No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Multi-Specialty |
No | 2081P0301X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Brain Injury Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 250H176210 | Other | BCBS |