Healthcare Provider Details

I. General information

NPI: 1518027606
Provider Name (Legal Business Name): UNIVERSAL HEALTH GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5761 W MAPLE RD
WEST BLOOMFIELD MI
48322-2270
US

IV. Provider business mailing address

5761 W MAPLE RD
WEST BLOOMFIELD MI
48322-2270
US

V. Phone/Fax

Practice location:
  • Phone: 248-626-6892
  • Fax: 248-855-2477
Mailing address:
  • Phone: 248-626-6892
  • Fax: 248-855-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101010930
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301064477
License Number StateMI

VIII. Authorized Official

Name: DR. SCOTT PHILIP ZACK
Title or Position: BOARD MEMBER
Credential: D.C.
Phone: 248-626-6892