Healthcare Provider Details
I. General information
NPI: 1023214814
Provider Name (Legal Business Name): MIDWEST-WOODBRIDGE HEALTH CENTER,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
600 WOODBRIDGE ST
DETROIT MI
48226-4364
US
IV. Provider business mailing address
600 WOODBRIDGE ST
DETROIT MI
48226-4364
US
V. Phone/Fax
- Phone: 313-568-1433
- Fax:
- Phone: 313-568-1433
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2083X0100X |
| Taxonomy | Occupational Medicine Physician |
| License Number | |
| License Number State | MI |
VIII. Authorized Official
Name:
MARK
B
SAFFER
Title or Position: CEO
Credential: DPM
Phone: 313-586-6038