Healthcare Provider Details

I. General information

NPI: 1679883490
Provider Name (Legal Business Name): CITY OF DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 E JEFFERSON AVE # 100
DETROIT MI
48207-4222
US

IV. Provider business mailing address

3245 E. JEFFERSON
DETROIT MI
48207-4222
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4000
  • Fax: 313-876-0475
Mailing address:
  • Phone: 313-876-4000
  • Fax: 313-876-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: KANZONI ASABIGI
Title or Position: GENERAL MANAGER
Credential:
Phone: 313-876-4000