Healthcare Provider Details

I. General information

NPI: 1871896332
Provider Name (Legal Business Name): ST. JOHN MACOMB-OAKLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 SCHOENHERR RD SUITE 200
WARREN MI
48088-6683
US

IV. Provider business mailing address

27450 SCHOENHERR RD SUITE 200
WARREN MI
48088-6683
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7860
  • Fax: 586-582-7861
Mailing address:
  • Phone: 586-582-7860
  • Fax: 586-582-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. JENNIFER JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 877-996-9975