Healthcare Provider Details

I. General information

NPI: 1336607431
Provider Name (Legal Business Name): INSTITUTE FOR POPULATION HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19830 JAMES COUZENS FWY
DETROIT MI
48235-1910
US

IV. Provider business mailing address

19830 JAMES COUZENS FWY
DETROIT MI
48235-1910
US

V. Phone/Fax

Practice location:
  • Phone: 313-309-9350
  • Fax: 313-309-9350
Mailing address:
  • Phone: 313-309-9350
  • Fax: 313-309-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY WILLIAMSON
Title or Position: REVENUE MANAGER, BILLER
Credential:
Phone: 313-390-9350