NPI 1114384757

University Physician Group

Organisation Eyewear Supplier Southfield, MI

Practice location

Address: 26400 W 12 Mile Rd Suite 60, Southfield, MI 48034-1774
Phone: (248) 594-6702
Fax: (248) 594-6738
Mailing address: 1560 E. Maple Rd. Suite 400-Credentialing, Troy, MI 48083-1138

Authorised official

Name: Jeffery P Kohlitz
Title: Chief Financial Officer
Phone: (248) 581-5930

Registered specialties

Eyewear Supplier Primary

Suppliers Taxonomy 332H00000X Licence 4301054761 (MI)

Other Eyewear Supplier providers in Michigan →

Registry record

NPI: 1114384757
Entity type: Organization
NPI issued: 27 Jan 2016
Record last updated: 1 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.