NPIMap

Organization Active NPI

University Physician Group

Doing business as Wayne State University Physician Group

  • Psychologist
  • Detroit, MI
National Provider Identifier
1366481160
Registry record updated Oct 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
UNIVERSITY PHYSICIAN GROUP
Doing business as
Wayne State 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
Last updated
Oct 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2016

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
0P32060OtherMIMEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST
0H22874OtherMIBCBSM GROUP NUMBER

Other names 1

  • Wayne State University Physician Group Doing business as

National Provider Directory

National Provider Directory

Locations

3901 Chrysler Dr
Detroit, MI 48201
Phone (313) 577-7523

3901 Chrysler Dr
#P
Detroit, MI 48201
Phone (313) 993-3434

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": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST",
            "identifier": "0P32060",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP NUMBER",
            "identifier": "0H22874",
            "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.

Verify at the official NPI Registry.