Provider Demographics
NPI:1427833383
Name:UNIVERSITY OF DETROIT MERCY
Entity type:Organization
Organization Name:UNIVERSITY OF DETROIT MERCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:313-993-1951
Mailing Address - Street 1:4001 W MCNICHOLS RD
Mailing Address - Street 2:STUDENT UNION 263
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3038
Mailing Address - Country:US
Mailing Address - Phone:313-993-1951
Mailing Address - Fax:313-993-1011
Practice Address - Street 1:41555 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3103
Practice Address - Country:US
Practice Address - Phone:313-494-6954
Practice Address - Fax:313-494-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty