Healthcare Provider Details

I. General information

NPI: 1366486763
Provider Name (Legal Business Name): DETROIT MACOMB HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 E JEFFERSON AVE
DETROIT MI
48214-3707
US

IV. Provider business mailing address

7733 E JEFFERSON AVE
DETROIT MI
48214-3707
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4254
  • Fax:
Mailing address:
  • Phone: 313-499-4254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MUNROE
Title or Position: PRESIDENT
Credential:
Phone: 313-499-4108