Provider Demographics
NPI:1770073199
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:ASSO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAYFES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-936-2047
Mailing Address - Street 1:700 KMS PL
Mailing Address - Street 2:3621 S STATE ST
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-647-5005
Mailing Address - Fax:
Practice Address - Street 1:24 FRANK LLOYD WRIGHT DR
Practice Address - Street 2:DOMINOS FARMS LOBBY C SUITE 1300
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-998-2475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty