Healthcare Provider Details

I. General information

NPI: 1578891966
Provider Name (Legal Business Name): ST JOHN MACOMB OAKLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD SUITE 1829
WARREN MI
48093-3472
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN FIELD
Title or Position: SR. DIRECTOR
Credential:
Phone: 586-753-0275