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General NPI Number Information
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NPI Number | 1083762686
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MICHIGAN- MEDSPORT
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20321 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-1411
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Country | US
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Telephone | 248-888-9000
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Fax | 248-888-9115
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Provider Business Mailing Address
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Address Line | 9060 KINLOCH
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City | REDFORD
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State | MI
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Zip | 48239-1884
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Country | US
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Telephone | 313-937-0018
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Fax |
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Authorized Official
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Title or Position | CLINICAL ATHLETIC TRAINER
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Name | MRS. MELINA LYNN HOLYSZKO
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Credential | ATC
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Telephone | 734-930-7421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | MI
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