MEDICARE: BOTSFORD GENERAL HOSPITAL

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1609900828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOTSFORD GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28100 GRAND RIVER AVE
Second Line	:	SUITE 306 SOUTH
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5967
Country	:	US
Telephone Number	:	947-521-2649
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR SHARED SERVICES
Name	:	LESLEY WILLBRANDT
Credential	:
Telephone Number	:	947-522-1911

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/16/2019

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