Healthcare Provider Details

I. General information

NPI: 1659558765
Provider Name (Legal Business Name): MERCY MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MACOMB ST
MONROE MI
48162-7815
US

IV. Provider business mailing address

718 N MACOMB ST
MONROE MI
48162-7815
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1440
  • Fax: 734-240-1550
Mailing address:
  • Phone: 734-240-1440
  • Fax: 734-240-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIANOUSH KHAGHNAY
Title or Position: GROUP REP
Credential: MD
Phone: 734-240-1442