=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790891026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENTS OF THE UNIVERSITY OF MICHIGAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 FLETCHER
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48109-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-764-7387
-----------------------------------------------------
Fax | 734-647-8777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 FLETCHER
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48109-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-764-7387
-----------------------------------------------------
Fax | 734-647-8777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ROBERT A WINFIELD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 734-936-6390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | 5301002449
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------