Healthcare Provider Details

I. General information

NPI: 1356510085
Provider Name (Legal Business Name): DETROIT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 2E
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST STE 2E
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301090867
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4301090867
License Number StateMI

VIII. Authorized Official

Name: NOUREDIN ALEBOUYEH
Title or Position: RESIDENT
Credential: M.D.
Phone: 313-974-6157