MEDICARE: TRINITY HEALTH MICHIGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5301007421	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1275676066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HEALTH MICHIGAN

Provider Business Mailing Address
First Line	:	5555 CONNER ST
Second Line	:	SUITE 2691
City	:	DETROIT
State	:	MI
Zip	:	48213-3448
Country	:	US
Telephone Number	:	313-579-4004
Fax Number	:	313-267-0057

Provider Business Practice Location Address
First Line	:	5555 CONNER ST STE 2691
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3812
Country	:	US
Telephone Number	:	313-692-8400
Fax Number	:	313-692-8437

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. TAWANA MIDDLE NETTLES-ROBINSON
Credential	:
Telephone Number	:	313-692-8400

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	12/16/2022

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Directions to “TRINITY HEALTH MICHIGAN ” Practice Location

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