Healthcare Provider Details

I. General information

NPI: 1356460323
Provider Name (Legal Business Name): SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD PEDIATRICS
HOWELL MI
48843
US

IV. Provider business mailing address

5301 E HURON RIVER DR PO BOX 993, MC 69504
YPSILANTI MI
48197-1051
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-6000
  • Fax:
Mailing address:
  • Phone: 734-712-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARRY FAJA
Title or Position: PRESIDENT CEO
Credential:
Phone: 734-712-3791