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General NPI Number Information
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NPI Number | 1023788148
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Entity Type | Organization
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Legal Business Name | IHA OOMA PRIMARY LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 6770 DIXIE HWY STE 303
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City | CLARKSTON
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State | MI
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Zip | 48346-2090
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Country | US
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Telephone | 248-625-0030
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Fax | 248-625-4403
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHEIF OPERATING OFFICER & PRESIDENT
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Name | CYNTHIA A ELLIOTT
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Credential |
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Telephone | 734-327-0872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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