Healthcare Provider Details

I. General information

NPI: 1902817620
Provider Name (Legal Business Name): ST JOHN MACOMB-OAKLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD ER DEPARTMENT
WARREN MI
48093-3472
US

IV. Provider business mailing address

PO BOX 673898
DETROIT MI
48267-3898
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5028
  • Fax:
Mailing address:
  • Phone: 800-531-5788
  • Fax: 586-296-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DARROCH
Title or Position: MANAGER, FINANCE
Credential:
Phone: 586-753-0305