Healthcare Provider Details

I. General information

NPI: 1750470589
Provider Name (Legal Business Name): ST JOHN DETROIT MACOMB HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD 204
MADISON HEIGHTS MI
48071-3491
US

IV. Provider business mailing address

25925 TELEGRAPH RD 210
SOUTHFIELD MI
48034-2518
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-7326
  • Fax: 248-967-7330
Mailing address:
  • Phone: 248-746-3218
  • Fax: 248-746-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA ELLEN WHITMAN
Title or Position: DIRECTOR PBS
Credential:
Phone: 248-746-3218