Basic Information
| Provider Information | |||||||||
| NPI: | 1023134012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY PRIMARY CARE PRACTICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UHMP - OPTHALMOGISTS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 772040 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482772040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163835900 | ||||||||
| FaxNumber: | 2163835933 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 MENTOR AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440604497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163835900 | ||||||||
| FaxNumber: | 2163835933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, UH CLINICAL NETWORK | ||||||||
| AuthorizedOfficialTelephone: | 5135588090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.