Healthcare Provider Details

I. General information

NPI: 1962183921
Provider Name (Legal Business Name): HEALTH UNIT ON DAVISON AVENUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13240 WOODROW WILSON ST
DETROIT MI
48238-3692
US

IV. Provider business mailing address

13240 WOODROW WILSON ST
DETROIT MI
48238-3692
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-8446
  • Fax: 313-865-8474
Mailing address:
  • Phone: 313-865-8446
  • Fax: 313-865-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY J WILSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 810-580-1805