# UNIVERISTY AFFILIATED NEUROLOGISTS

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

## Provider details

- **NPI number:** 1952330474
- **Authorized official:** ROBERT LISAK M.D. (DEPARTMENT CHAIR)
- **Authorized official phone:** (313) 577-1249

## Contact information

- **Practice address:** 4201 ST. ANTOINE ST, SUITE 8D, DETROIT, MI 48201
- **Practice address phone:** (313) 745-4275
- **Mailing address:** 3800 WOODWARD AVE., SUITE 702, DETROIT, MI 48201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103G00000X | Clinical Neuropsychologist | — | NULL | — |
| 103G00000X | Clinical Neuropsychologist | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 09/11/2025