Healthcare Provider Details

I. General information

NPI: 1265635593
Provider Name (Legal Business Name): HURON GASTROENTEROLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD
HOWELL MI
48843-1002
US

IV. Provider business mailing address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6262
  • Fax: 734-712-2820
Mailing address:
  • Phone: 734-434-6262
  • Fax: 734-712-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: LANA COOPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 734-528-1405