Healthcare Provider Details

I. General information

NPI: 1467366096
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MICHGIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W BIG BEAVER RD
TROY MI
48084
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4000
  • Fax:
Mailing address:
  • Phone: 734-936-4000
  • Fax: 734-615-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE KAIKKONEN
Title or Position: MANAGER PROVIDER ENROLLMENT
Credential:
Phone: 734-936-9610