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General NPI Number Information
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NPI Number | 1356556575
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PHYSICIAN GROUP
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 16836 NEWBURGH RD
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City | LIVONIA
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State | MI
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Zip | 48154-1600
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Country | US
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Telephone | 734-464-4220
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Fax | 734-464-5885
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Provider Business Mailing Address
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Address Line | 1560 E MAPLE RD STE 400-CREDENTIALING DEPT.
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City | TROY
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State | MI
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Zip | 48083-1138
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Country | US
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Telephone | 248-581-5973
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Fax | 248-581-5640
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JEFFERY P KOHLITZ
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Credential |
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Telephone | 248-581-5930
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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