Healthcare Provider Details

I. General information

NPI: 1326428285
Provider Name (Legal Business Name): IPC HOSPITALIST COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 HUNTWOOD PARK CT
WEST BLOOMFIELD MI
48324-3998
US

IV. Provider business mailing address

1628 HUNTWOOD PARK CT
WEST BLOOMFIELD MI
48324-3998
US

V. Phone/Fax

Practice location:
  • Phone: 313-530-9188
  • Fax:
Mailing address:
  • Phone: 313-530-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5601004921
License Number StateMI

VIII. Authorized Official

Name: MELODY SHAW
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 313-530-9188