UNIVERSITY AFFILIATED NEUROLOGISTS, INC (NPI# 1124249420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124249420 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY AFFILIATED NEUROLOGISTS, INC |
| Practice Address |
4201 Saint Antoine St Suite 8d Detroit MI 48201-2153 |
| Mailing Address |
3800 Woodward Ave Suite 600 Detroit MI 48201-2061 |
| Practice Telephone | 3137454275 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SUZANNE WASMUNDT (DIRECTOR) |
| Authorized Official Telephone | 3135778958 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM GROUP NUMBER | 0H24771 | 01 |
| Street Address |
4201 SAINT ANTOINE ST SUITE 8D |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760477871 | John Mckay Perkowski | Nurse Anesthetist, Certified Registered | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2005-09-14 |
| 1013517028 | Madappulli Arachchige Wickrama | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-10-28 |
| 1134731466 | Helda Bacall | Nurse Practitioner | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-08-18 |
| 1568088680 | Michelle De Varennes | Physician Assistant | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-24 |
| 1235754144 | Saren Yeranosian | Pharmacist | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-16 |
| 1083239230 | Jacqueline Ferraro-jaworski | Pharmacist | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-13 |
| 1770107617 | Zamaan Sayeed Sohel | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-06 |
| 1881218790 | Erin Marie Dinnell | Nurse Practitioner | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-05 |
| 1487276721 | Andrew R Kumar | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-05-09 |
| 1598386005 | Kayla Richelle Robinson | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-05-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
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| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588828453 | Jin Lee Kim | Clinical Neuropsychologist | 1 Ford Pl Ste 1e, Detroit, MI 48202-3450 | 2008-07-10 |
| 1841340312 | Raymond Mckinley Campbell IIi | Clinical Neuropsychologist | 1511 1st St, Suite 1308, Detroit, MI 48226-1351 | 2007-01-10 |
| 1104939107 | Jannel M Phillips | Clinical Neuropsychologist | 1 Ford Place, Detroit, MI 48202 | 2006-08-16 |
| 1952330474 | Univeristy Affiliated Neurologists | Clinical Neuropsychologist | 4201 St. Antoine St, Suite 8d, Detroit, MI 48201 | 2006-06-30 |
| 1457390254 | University Physician Group | Clinical Neuropsychologist | 4201 Saint Antoine St., Suite 8d, Detroit, MI 48201 | 2006-06-06 |
| 1225038904 | Scott Richard Millis | Clinical Neuropsychologist | 261 Mack Ave, Rehabilitation Institute of Michigan, Rm 552, Detroit, MI 48201-2417 | 2005-07-26 |
| 1285116384 | Allison Josephine Lake | Clinical Neuropsychologist | 261 Mack Ave Ste 555, Detroit, MI 48201-2417 | 2018-09-05 |
| 1487193207 | Vilija Petrauskas | Clinical Neuropsychologist | 1 Ford Pl Ste 1e, Detroit, MI 48202-3450 | 2017-02-13 |
| 1053659482 | Brent Funk | Clinical Neuropsychologist | 1 Ford Pl, 1e, Detroit, MI 48202-3450 | 2013-01-18 |
| 1215295191 | Kathleen Margaret Hagelthorn | Clinical Neuropsychologist | 1 Ford Pl Ste 2e, Detroit, MI 48202-3450 | 2012-04-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.