Healthcare Provider Details

I. General information

NPI: 1194978213
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MICHIGAN-PEDIATRIC SURGERY OFFSITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4642 GENESYS PARKWAY
GRAND BLANC MI
48439-8067
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-5830
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A SPAHLINGER
Title or Position: EXEC MEDICAL DIRECTOR FACULTY GRP
Credential: MD
Phone: 734-936-3568