Organization
UNIVERSITY PHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH P. LEE (CHIEF ADMINISTRATIVE OFFICER)
(313) 577-8112
Entity
Organization
Contact information
Practice address
4201 SAINT ANTOINE ST., SUITE 8D, DETROIT, MI 48201
(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
Enumeration date
06/06/2006
Last updated
12/12/2007
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