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General NPI Number Information
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NPI Number | 1619262235
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Entity Type | Organization
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Legal Business Name | WAYNE STATE UNIVERSITY/DMC
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 8316 VIRGIL ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1520
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Country | US
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Telephone | 313-319-4168
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Fax |
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Provider Business Mailing Address
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Address Line | 8316 VIRGIL ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-1520
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Country | US
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Telephone | 313-319-4168
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Fax |
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Authorized Official
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Title or Position | NEUROPHYSIOLOGY FELLOW
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Name | DR. TEMENUZHKA GEORGIEVA MIHAYLOVA
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Credential | MD, PHD
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Telephone | 313-319-4168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301088076
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License Number State | MI
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