Healthcare Provider Details

I. General information

NPI: 1720123029
Provider Name (Legal Business Name): LINWOOD WESTINGHOUSE BLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 W GRAND BLVD
DETROIT MI
48202-2612
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2411
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-4200
  • Fax: 313-875-5611
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301038485
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: