Healthcare Provider Details

I. General information

NPI: 1093828303
Provider Name (Legal Business Name): BOTSFORD GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28100 GRAND RIVER AVE SUITE 301
FARMINGTON HILLS MI
48336-5967
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 947-521-1320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: NANCY SUSICK
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 947-522-3338