Healthcare Provider Details

I. General information

NPI: 1134457435
Provider Name (Legal Business Name): BIO ENERGY MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 PROFESSIONAL DR
ANN ARBOR MI
48104-5128
US

IV. Provider business mailing address

3131 PROFESSIONAL DR
ANN ARBOR MI
48104-5128
US

V. Phone/Fax

Practice location:
  • Phone: 734-995-3200
  • Fax: 734-995-4254
Mailing address:
  • Phone: 734-995-3200
  • Fax: 734-995-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301050438
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301091374
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704136630
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704196627
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES ROBERT NEUENSCHWANDER
Title or Position: PRESIDENT/INCORPORATOR
Credential: MD
Phone: 734-995-3200