Healthcare Provider Details

I. General information

NPI: 1326268483
Provider Name (Legal Business Name): DETROIT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R
DETROIT MI
48202
US

IV. Provider business mailing address

42069 WATERWHEEL RD
NORTHVILLE MI
48168
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-2604
  • Fax:
Mailing address:
  • Phone: 248-349-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number4301086482
License Number StateMI

VIII. Authorized Official

Name: MRS. TEREASA CORCORAN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 313-745-2260