Healthcare Provider Details

I. General information

NPI: 1508188491
Provider Name (Legal Business Name): DETROIT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 1017
DETROIT MI
48201-2020
US

IV. Provider business mailing address

4160 JOHN R ST SUITE 1017
DETROIT MI
48201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4123
  • Fax: 313-745-8222
Mailing address:
  • Phone: 313-745-4123
  • Fax: 313-745-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6315024455
License Number StateMI

VIII. Authorized Official

Name: CHRISTINE T BASSETT
Title or Position: PROGRAM MANAGER
Credential:
Phone: 313-745-4123