Healthcare Provider Details

I. General information

NPI: 1376905992
Provider Name (Legal Business Name): IHA HEALTH SERVICES ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 MCAULEY DR DEPARTMENT OF PEDIATRICS
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: 734-712-3325
  • Fax: 734-712-5525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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