Provider Demographics
NPI:1861489502
Name:MICHIGAN INSTITUTE FOR HEALTH ENHANCEMENT
Entity type:Organization
Organization Name:MICHIGAN INSTITUTE FOR HEALTH ENHANCEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALGIRDAS
Authorized Official - Middle Name:ANTANAS
Authorized Official - Last Name:JUOCYS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-475-4702
Mailing Address - Street 1:4986 N. ADAMS RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-475-4880
Mailing Address - Fax:248-475-5777
Practice Address - Street 1:4986 N. ADAMS RD.
Practice Address - Street 2:SUITE D
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-4880
Practice Address - Fax:248-475-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
IL850328133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty