MEDICARE: REGENTS OF THE UNIVERSITY OF MICHIGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1639333131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS OF THE UNIVERSITY OF MICHIGAN

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:	700 KMS PLACE
City	:	ANN ARBOR
State	:	MA
Zip	:	48108
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 W MAPLE RD
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48322-2294
Country	:	US
Telephone Number	:	248-855-2071
Fax Number	:

Authorized Official
Title or Position	:	EXEC MEDICAL DIRECTOR
Name	:	DAVID A SPAHLINGER
Credential	:
Telephone Number	:	734-936-3568

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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Directions to “REGENTS OF THE UNIVERSITY OF MICHIGAN ” Practice Location

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