Organization
UNIVERSITY AFFILIATED NEUROLOGISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE WASMUNDT (DIRECTOR)
(313) 577-8958
Entity
Organization
Contact information
Practice address
4201 SAINT ANTOINE ST, SUITE 8D, DETROIT, MI 48201-2153
(313) 745-4275
Mailing address
3800 WOODWARD AVE, SUITE 600, DETROIT, MI 48201-2061
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H24771
BCBSM GROUP NUMBER
MI
Enumeration date
05/02/2007
Last updated
08/22/2020
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