Healthcare Provider Details

I. General information

NPI: 1790343374
Provider Name (Legal Business Name): IHA HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MAIN ST STE A
BROOKLYN MI
49230-9114
US

IV. Provider business mailing address

PO BOX 446
ANN ARBOR MI
48106-0446
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-8033
  • Fax: 517-592-3959
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA A ELLIOTT
Title or Position: PRESIDENT AND COO
Credential:
Phone: 734-327-0872