Healthcare Provider Details

I. General information

NPI: 1811937519
Provider Name (Legal Business Name): METROPOLITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9606
US

IV. Provider business mailing address

985 GEZON PKWY SW
WYOMING MI
49509-9563
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7200
  • Fax: 616-252-7830
Mailing address:
  • Phone: 616-252-4655
  • Fax: 616-252-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number410060
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number410060
License Number StateMI

VIII. Authorized Official

Name: TIMOTHY E SUSTERICH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-252-5203