Healthcare Provider Details

I. General information

NPI: 1871791285
Provider Name (Legal Business Name): UNIVERSITY OF MICHIGAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 THOMPSON ST SUITE 2
ANN ARBOR MI
48104-2264
US

IV. Provider business mailing address

328 THOMPSON ST SUITE 2
ANN ARBOR MI
48104-2264
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-2496
  • Fax:
Mailing address:
  • Phone: 734-276-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6801072434
License Number StateMI

VIII. Authorized Official

Name: MS. FLORENCE O'GARA
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW, RN
Phone: 734-615-8592