Healthcare Provider Details

I. General information

NPI: 1790891026
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FLETCHER
ANN ARBOR MI
48109-1050
US

IV. Provider business mailing address

207 FLETCHER
ANN ARBOR MI
48109-1050
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-7387
  • Fax: 734-647-8777
Mailing address:
  • Phone: 734-764-7387
  • Fax: 734-647-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5301002449
License Number StateMI

VIII. Authorized Official

Name: ROBERT A WINFIELD
Title or Position: DIRECTOR
Credential: MD
Phone: 734-936-6390