Organization
UNIVERSITY PHYSICIAN GROUP
Active
Other names
Wayne State University Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE K STILLER (CHIEF FINANCIAL OFFICER)
(248) 581-5943
Entity
Organization
Contact information
Practice address
1455 S LAPEER RD, SUITE 110, LAKE ORION, MI 48360-1468
(248) 814-7139
(248) 814-7997
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1138
(248) 581-5973
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
4301054761
MI
Other
Enumeration date
07/23/2013
Last updated
06/01/2016
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