Active NPI
University Physician Group
- Psychologist
- Detroit, MI
National Provider Identifier
1366481160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- UNIVERSITY PHYSICIAN GROUP
- Practice address
- 3901 Chrysler Dr
Tolan Park
Detroit, MI 48201-2167 - Phone
- (888) 362-7792
- Fax
- (313) 993-1372
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jeffery P Kohlitz
- Title
- Chief Financial Officer
- Phone
- (248) 581-5930
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
3901 Chrysler Dr
Tolan Park
Detroit, MI 48201-2167
Mailing address
1560 E. Maple Rd.
Suite 400-Credentialing Dept.
Troy, MI 48083-1138
Phone (248) 581-5973
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0H22874 | Other | MI | BCBSM GROUP NUMBER |
| 0P32060 | Other | MI | MEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST |
Other names 1
- Wayne State University Physician Group
National Provider Directory
National Provider DirectoryLocations
44000 W Twelve Mile Rd
Ste 205
Novi, MI 48377
Phone (248) 374-0077
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1477440000000",
"number": "1366481160",
"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 DEPT.",
"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": "3901 CHRYSLER DR",
"address_2": "TOLAN PARK",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012167",
"telephone_number": "888-362-7792",
"fax_number": "313-993-1372"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNIVERSITY PHYSICIAN GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-06",
"last_updated": "2016-10-26",
"status": "A",
"authorized_official_last_name": "KOHLITZ",
"authorized_official_first_name": "JEFFERY",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "248-581-5930",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM GROUP NUMBER",
"identifier": "0H22874",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST",
"identifier": "0P32060",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Wayne State University Physician Group",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.