Healthcare Provider Details

I. General information

NPI: 1881633022
Provider Name (Legal Business Name): SINAI HOSPITAL OF GREATER DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR SINAI GRACE PHYSICIANS ASSISTANT GROUP
DETROIT MI
48235-2624
US

IV. Provider business mailing address

6071 W OUTER DR SINAI GRACE PHYSICIANS ASSISTANT GROUP
DETROIT MI
48235-2624
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-3300
  • Fax: 810-765-8169
Mailing address:
  • Phone: 313-966-3300
  • Fax: 810-765-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RONALD XAVIER STAVALE
Title or Position: MANAGER
Credential: PAC
Phone: 313-440-4479