Healthcare Provider Details

I. General information

NPI: 1174809826
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/30/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE SUITE 725
LANSING MI
48912
US

IV. Provider business mailing address

3621 S STATE ST PROVIDER ENROLLMENT
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5599
  • Fax:
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DAVID CHRISTOPHER MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 734-936-3568