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General NPI Number Information
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NPI Number | 1760033245
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Entity Type | Organization
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Legal Business Name | IHA HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 5505 S OLD US 23 STE 100
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City | BRIGHTON
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State | MI
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Zip | 48116-7524
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Country | US
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Telephone | 810-494-6840
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Fax | 810-494-6839
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR LBBY 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 | 734-747-6766
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND COO
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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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