Healthcare Provider Details

I. General information

NPI: 1760535066
Provider Name (Legal Business Name): PONTIAC GENERAL HOSPITAL AND MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 W HURON ST
PONTIAC MI
48341-1601
US

IV. Provider business mailing address

8198 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 248-857-7200
  • Fax:
Mailing address:
  • Phone: 248-857-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN GRAHAM
Title or Position: CEO
Credential:
Phone: 248-857-7200