University Physician Group

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

4301054761 Issued in MI

Legal business name

UNIVERSITY PHYSICIAN GROUP

Doing business as

Wayne State University Physician Group

Practice address

1455 S Lapeer Rd
Suite 110
Lake Orion, MI 48360-1468

Phone

(248) 814-7139

Fax

(248) 814-7997

NPI assigned

Jul 23, 2013

Last updated

Jun 1, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diane K Stiller

Title

Chief Financial Officer

Phone

(248) 581-5943

Specialties & licenses 1

Addresses

Other names 1

• Wayne State University Physician Group Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1215379938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "248-581-5973",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 S LAPEER RD",
            "address_2": "SUITE 110",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601468",
            "telephone_number": "248-814-7139",
            "fax_number": "248-814-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "STILLER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "248-581-5943"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "4301054761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne State University Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paige Tranchida
• Troy Urology Lake Orion LLC
• Lori Tunney, LLMSW
• Madeline Turner, DO
• Laura Elizabeth Uhlianuk
• Ann Marie Van Gessel
• Huyen Thi Van, PHARMD, RPH
• Veronica Marilena Varzaru, RPH
• Carmella Josephine Venturini, FNP-C
• Lynne Katherine Versace, RN

• Eyewear Supplier in Lake Orion, MI
• Providers in Lake Orion, MI by specialty
• Eyewear Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.