Healthcare Provider Details

I. General information

NPI: 1659538106
Provider Name (Legal Business Name): THE HEMOPHILA THROMBOPHILIA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5392
  • Fax:
Mailing address:
  • Phone: 313-745-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH T SCALLEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 313-745-6132