MEDICARE: IHA HEALTH SERVICES CORPORATION

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1700933314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHA HEALTH SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR
Second Line	:	PO BOX 0446, LOBBY J
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-327-0872
Fax Number	:	734-327-6308

Provider Business Practice Location Address
First Line	:	2305 GENOA BUSINESS PARK DRIVE
Second Line	:	SUITE 208
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9309
Country	:	US
Telephone Number	:	810-494-6896
Fax Number	:

Authorized Official
Title or Position	:	VP/CHIEF OPERATING OFFICER
Name	:	CYNTHIA A ELLIOTT
Credential	:
Telephone Number	:	734-747-6766

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	06/03/2011

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