Healthcare Provider Details

I. General information

NPI: 1821369620
Provider Name (Legal Business Name): CITY OF DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1151 TAYLOR ST
DETROIT MI
48202-1732
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4000
  • Fax: 313-876-0177
Mailing address:
  • Phone: 313-876-4717
  • Fax: 313-876-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: KANZONI ASABIGI
Title or Position: SR. PUBLIC HEALTH ADVISOR
Credential:
Phone: 313-876-4000