Organization
UNIVERSITY PHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE K STILLER (CHIEF FINANCIAL OFFICER)
(248) 581-5943
Entity
Organization
Contact information
Practice address
4700 SCHAEFER RD, SUITE 165, DEARBORN, MI 48126-3698
(313) 945-7724
(313) 945-8731
Mailing address
1560 E. MAPLE RD., SUITE 400-CREDENTIALING DEPT., TROY, MI 48083-1138
(248) 581-5973
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
4301054761
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5717980004
NGS
MI
Enumeration date
10/13/2010
Last updated
06/01/2016
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