Healthcare Provider Details

I. General information

NPI: 1922068378
Provider Name (Legal Business Name): CHILDRENS HOSPITAL OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 02/01/2011
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: 313-578-2564
  • Fax: 313-578-3964
Mailing address:
  • Phone: 313-578-2564
  • Fax: 313-578-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JACKIE HILL
Title or Position: VICE PRESIDENT OF FINANCE
Credential: VP
Phone: 313-578-8564