Healthcare Provider Details

I. General information

NPI: 1922372564
Provider Name (Legal Business Name): MICHAEL URBAN B.S., CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 AVIS DR
ANN ARBOR MI
48108-9649
US

IV. Provider business mailing address

4501 SNELL AVE APT 2704
SAN JOSE CA
95136-2346
US

V. Phone/Fax

Practice location:
  • Phone: 800-638-7564
  • Fax:
Mailing address:
  • Phone: 734-945-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number2086
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: