Provider Demographics
NPI:1972755676
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: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:734-973-1577
Mailing Address - Fax:734-973-2977
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:734-973-1577
Practice Address - Fax:734-973-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0366620291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23HL03Medicare Oscar/Certification