Healthcare Provider Details

I. General information

NPI: 1770853251
Provider Name (Legal Business Name): DETROIT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 05/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR EMERGENCY MEDICINE DEPARTMENT
DETROIT MI
48235-2624
US

IV. Provider business mailing address

1431 WASHINGTON BLVD APT 2714
DETROIT MI
48226-1732
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1020
  • Fax:
Mailing address:
  • Phone: 913-706-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN BROWNLOW
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 313-966-1020