Healthcare Provider Details

I. General information

NPI: 1215177019
Provider Name (Legal Business Name): DETROIT MEDICAL CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HEATHER DRIVE
DEARBORN MI
48216
US

IV. Provider business mailing address

5000 HEATHER DRIVE
DEARBORN MI
48216
US

V. Phone/Fax

Practice location:
  • Phone: 904-316-4910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA VETTESE
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 313-745-4832