University Physician Group
Dietitian, Registered in Detroit, MI. Organization (NPI-2).
NPI number1265472575
StatusActive
Last updated in NPPESOct 26, 2016
Details
- NPI
- 1265472575
- Entity type
- Organization (NPI-2)
- Legal business name
- University Physician Group
- Organization subpart
- No
- Enumeration date
- Jun 7, 2006
- Last updated
- Oct 26, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | – | – | Yes |
Other names
- Wayne State University Physician Group (Doing Business As)
Practice location
4201 Saint Antoine StSuite 4c
Detroit, MI 48201-2153
Phone 313-745-4525
Mailing address
1560 E. Maple Rd.Suite 400-Credentialing Dept.
Troy, MI 48083-1138
Phone 248-581-5973 · Fax 248-581-5640
Authorized official
Jeffery P Kohlitz
Chief Financial Officer
2485815930
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