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General NPI Number Information
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NPI Number | 1063741270
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Entity Type | Organization
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Legal Business Name | ADULT NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST 4J UHC
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-1784
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 FOOTHILLS DR
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-1559
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Country | US
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Telephone | 248-363-4060
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DARREN RONALD FUERST
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Credential | PHD
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Telephone | 248-363-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301008758
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License Number State | MI
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