MEDICARE: FIROZA B. VAN HORN, PSY., D., PC.

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	103G00000X	Clinical Neuropsychologist	6301007958	MI

General Provider Information

NPI Number	:	1649299504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIROZA B. VAN HORN, PSY., D., PC.

Provider Business Mailing Address
First Line	:	39520 WOODWARD AVE
Second Line	:	SUITE 210
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39520 WOODWARD AVE
Second Line	:	SUITE 210
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5054
Country	:	US
Telephone Number	:	248-647-8412
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FIROZA B. VAN HORN
Credential	:	PSY, D
Telephone Number	:	248-647-8412

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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