Healthcare Provider Details

I. General information

NPI: 1609724731
Provider Name (Legal Business Name): SJMH MEDICAL PRACTICE-SMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-3000
  • Fax:
Mailing address:
  • Phone: 248-858-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAUL GUSHO
Title or Position: CFO
Credential:
Phone: 231-672-3886