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General NPI Number Information
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NPI Number | 1942556634
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF MICHIGAN
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 8001 CHALLIS ROAD
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City | BRIGHTON
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State | MI
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Zip | 48116-7446
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Country | US
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Telephone | 810-227-9510
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST PROVIDER ENROLLMENT
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID CHRISTOPHER MILLER
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Credential |
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Telephone | 734-936-3568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | MI
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