Provider Demographics
NPI:1730230053
Name:UNIVERSITY OF MICHIGAN
Entity type:Organization
Organization Name:UNIVERSITY OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, CSCS
Authorized Official - Phone:734-930-7400
Mailing Address - Street 1:8736 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8736 BARRINGTON DR
Practice Address - Street 2:
Practice Address - City:SUPERIOR TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48198-3289
Practice Address - Country:US
Practice Address - Phone:734-930-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty