| Organization Name: | UNIVERSITY PHYSICIAN GROUP |
| NPI Number: | 1215379938 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE K STILLER (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 1455 S Lapeer Rd Suite 110 Lake Orion |
| State: | MI US |
| Postal Code: | 483601468 |
| Phone Number: | 2488147139 |
| Fax Number: | 2488147997 |
| NPI Enumeration Date: | 07/23/2013 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | 4301054761 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |