Healthcare Provider Details

I. General information

NPI: 1801128657
Provider Name (Legal Business Name): MIDMICHIGAN NEUROPSYCHOLOGY ASSOCIATES, P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 TOWNE CENTRE RD. SUITE 304
SAGINAW MI
48604-2821
US

IV. Provider business mailing address

4705 TOWNE CENTRE RD. SUITE 304
SAGINAW MI
48604-2821
US

V. Phone/Fax

Practice location:
  • Phone: 989-921-5100
  • Fax: 989-921-5104
Mailing address:
  • Phone: 989-921-5100
  • Fax: 989-921-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301008040
License Number StateMI

VIII. Authorized Official

Name: DR. WILLIAM D MACINNES
Title or Position: MEMBER
Credential: PH.D.
Phone: 989-921-5100