Healthcare Provider Details

I. General information

NPI: 1003844614
Provider Name (Legal Business Name): BOTSFORD GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28080 GRAND RIVER AVE SUITE 306
FARMINGTON HILLS MI
48336-5966
US

IV. Provider business mailing address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-8182
  • Fax: 248-478-7179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLEY WILLBRANDT
Title or Position: DIRECTOR SHARED SERVICES
Credential:
Phone: 947-522-1911