Healthcare Provider Details

I. General information

NPI: 1033429394
Provider Name (Legal Business Name): CITY OF DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MACK AVE FL 1
DETROIT MI
48201-2416
US

IV. Provider business mailing address

100 MACK AVE FL 3
DETROIT MI
48201-2416
US

V. Phone/Fax

Practice location:
  • Phone: 313-480-3831
  • Fax: 313-877-9305
Mailing address:
  • Phone: 313-876-0349
  • Fax: 313-877-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDON ATKINS
Title or Position: DIRECTOR OF CLINICAL ADMINISTRATION
Credential:
Phone: 313-348-2883