Healthcare Provider Details

I. General information

NPI: 1073558094
Provider Name (Legal Business Name): CITY OF MADISON HEIGHTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31313 BRUSH
MADISON HEIGHTS MI
48071
US

IV. Provider business mailing address

300W 13 MILE RD
MADISON HEIGHTS MI
48071-1853
US

V. Phone/Fax

Practice location:
  • Phone: 248-837-2833
  • Fax: 248-588-3604
Mailing address:
  • Phone: 248-837-2833
  • Fax: 248-588-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number63 1009
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number631009
License Number StateMI

VIII. Authorized Official

Name: GREGORY LELITO
Title or Position: FIRE CHIEF
Credential:
Phone: 248-837-2833