MEDICARE: AMERICAN HEADACHE INSTITUTE LLC

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
1	261QP2000X	Physical Therapy Clinic/Center		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F35820	OTHER	MI	BLUE CROSS

General Provider Information

NPI Number	:	1699070250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEADACHE INSTITUTE LLC

Provider Business Mailing Address
First Line	:	878 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2740
Country	:	US
Telephone Number	:	248-601-9207
Fax Number	:	248-650-8670

Provider Business Practice Location Address
First Line	:	876 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2740
Country	:	US
Telephone Number	:	248-601-9207
Fax Number	:

Authorized Official
Title or Position	:	VP ADMINISTRATION
Name	:	CATHERINE IRELAND
Credential	:
Telephone Number	:	248-601-9207

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	08/22/2011

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