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NPI Code Detail

MEDICARE: DR. PAUL BYRON ESTENSON PHD

MEDICARE: DR. PAUL BYRON ESTENSON PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6301003813MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1680H146640OTHERMIBCBS OF MI

General Provider Information

NPI Number : 1184635534
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL BYRON ESTENSON PHD
Provider Business Mailing Address
First Line : 2395 OAK VALLEY DR
Second Line : SUITE 100
City : ANN ARBOR
State : MI
Zip : 48103-8943
Country : US
Telephone Number : 734-995-5181
Fax Number : 734-995-9011
Provider Business Practice Location Address
First Line : 2395 OAK VALLEY DR
Second Line : SUITE 100
City : ANN ARBOR
State : MI
Zip : 48103-8943
Country : US
Telephone Number : 734-995-5181
Fax Number : 734-995-9011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2009

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