Provider Demographics
NPI:1811144496
Name:THE REGENTS OF THE UNIVERSITY OF MICHIGAN
Entity type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PROFESSIONAL FEE BILLING
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:FABIANA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-647-5167
Mailing Address - Street 1:2364 BISHOP
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-647-5167
Mailing Address - Fax:
Practice Address - Street 1:2364 BISHOP
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-647-1636
Practice Address - Fax:734-763-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106646363LA2200X
MI4704134489363LF0000X
MI4704192578363LF0000X
MI4704196737363LF0000X
MI4704206913363LF0000X
MI4704121969363LF0000X
MI4704169272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871621078OtherNPI NUMBER
1316056005OtherNPI NUMBER
1083708200OtherNPI NUMBER
1962509539OtherNPI NUMBER
1265589626OtherNPI NUMBER
1053589325OtherNPI NUMBER
1104935824OtherNPI NUMBER