Healthcare Provider Details

I. General information

NPI: 1811002710
Provider Name (Legal Business Name): MICHIGAN HOSPITAL PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD ISU OBSERVATION UNIT
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING/PAYER CONTRACTING
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 313-982-5770
  • Fax: 313-982-5771
Mailing address:
  • Phone: 734-805-0488
  • Fax: 866-250-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: TOMMI A WHITE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 734-632-0175