Healthcare Provider Details

I. General information

NPI: 1982797106
Provider Name (Legal Business Name): MICHIGAN HEADACHE & NEUROLOGICAL INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 PROFESSIONAL DR
ANN ARBOR MI
48104-5131
US

IV. Provider business mailing address

3120 PROFESSIONAL DR
ANN ARBOR MI
48104-5131
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-6000
  • Fax: 734-677-2422
Mailing address:
  • Phone: 734-677-6000
  • Fax: 734-677-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT F MADDEN
Title or Position: ADMINISTRATOR
Credential: FACHE
Phone: 734-677-6000