Healthcare Provider Details

I. General information

NPI: 1437527975
Provider Name (Legal Business Name): NUCH OF MICHIGAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20599 MACK AVE
GROSSE POINTE MI
48236-1656
US

IV. Provider business mailing address

20599 MACK AVE
GROSSE POINTE MI
48236-1656
US

V. Phone/Fax

Practice location:
  • Phone: 877-654-0472
  • Fax: 469-893-7273
Mailing address:
  • Phone: 877-654-0472
  • Fax: 469-893-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2902