Healthcare Provider Details

I. General information

NPI: 1568900512
Provider Name (Legal Business Name): IHA HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 MCAULEY DR SUITE 2199
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 877-336-6307
  • Fax: 734-712-3855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ELLIOTT
Title or Position: PRESIDENT & CHIEF OPERATING OFFICER
Credential:
Phone: 734-747-6766