# EASTERN MICHIGAN UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346628534
- **Authorized official:** NIKOLIS GUSTAFSON ATC (ATHLETIC TRAINER)
- **Authorized official phone:** (612) 242-2676

## Contact information

- **Practice address:** 799 N HEWITT RD, YPSILANTI, MI 48197-1701
- **Practice address phone:** (734) 487-5179
- **Mailing address:** PO BOX 446, LESTER PRAIRIE, MN 55354-0446

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 3667518 | MI | Yes |

## Other

- **Enumeration date:** 05/08/2015
- **Last updated:** 05/08/2015