Healthcare Provider Details

I. General information

NPI: 1700832078
Provider Name (Legal Business Name): WASHTENAW MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 W CLARK RD SUITE 401
YPSILANTI MI
48197-1120
US

IV. Provider business mailing address

3145 W CLARK RD SUITE 401
YPSILANTI MI
48197-1120
US

V. Phone/Fax

Practice location:
  • Phone: 734-528-5700
  • Fax: 734-528-5701
Mailing address:
  • Phone: 734-528-5700
  • Fax: 734-528-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S. SANSON
Title or Position: PRESIDENT
Credential: MD
Phone: 734-528-5700