Organization
REGENTS OF THE UNIVERSITY OF MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CHRISTOPHER MILLER (PRESIDENT)
(734) 936-3568
Entity
Organization
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, PROVIDER ENROLLMENT, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TH0100X
Health Service Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680H161850
BCBS
MI
Enumeration date
07/13/2006
Last updated
05/03/2021
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