Healthcare Provider Details

I. General information

NPI: 1508010760
Provider Name (Legal Business Name): CHILDREN HOSPTIAL OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 BEAUBIEN ST APT 805
DETROIT MI
48201-2152
US

IV. Provider business mailing address

3737 BEAUBIEN ST APT 805
DETROIT MI
48201-2152
US

V. Phone/Fax

Practice location:
  • Phone: 917-301-1386
  • Fax:
Mailing address:
  • Phone: 917-301-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberL1335110
License Number StateMI

VIII. Authorized Official

Name: DR. JIE SUN
Title or Position: PEDIATRIC CARDIOLOGY FELLOW
Credential: M.D.
Phone: 917-301-1386