Healthcare Provider Details

I. General information

NPI: 1114061850
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42700 GARFIELD RD SUITE 100
CLINTON TOWNSHIP MI
48038-4201
US

IV. Provider business mailing address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

V. Phone/Fax

Practice location:
  • Phone: 586-532-3410
  • Fax:
Mailing address:
  • Phone: 313-745-0633
  • Fax: 313-745-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH SCALLEN
Title or Position: VP FINANCE
Credential: VP
Phone: 313-745-0633