Healthcare Provider Details

I. General information

NPI: 1497939607
Provider Name (Legal Business Name): DETROIT RECEIVING HOSPITAL & UNIVERSITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-578-2164
  • Fax: 313-578-3964
Mailing address:
  • Phone: 313-578-2164
  • Fax: 313-578-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number261QS0112X
License Number StateMI

VIII. Authorized Official

Name: MS. GLORIA LARKINS
Title or Position: VICE PRESIDENT FINANCE
Credential: VICE PRESIDENT
Phone: 313-578-2164