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General NPI Number Information
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NPI Number | 1861489502
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Entity Type | Organization
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Legal Business Name | MICHIGAN INSTITUTE FOR HEALTH ENHANCEMENT
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 4986 N. ADAMS RD. SUITE D
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City | ROCHESTER
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State | MI
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Zip | 48306-1416
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Country | US
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Telephone | 248-475-4880
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Fax | 248-475-5777
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Provider Business Mailing Address
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Address Line | 4986 N. ADAMS RD. SUITE D
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City | ROCHESTER
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State | MI
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Zip | 48306-1416
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Country | US
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Telephone | 248-475-4880
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Fax | 248-475-5777
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. ALGIRDAS ANTANAS JUOCYS
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Credential | D.O.
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Telephone | 248-475-4702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 850328
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License Number State | IL
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