Healthcare Provider Details

I. General information

NPI: 1013730332
Provider Name (Legal Business Name): TRINITY HEALTH-MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 6014
YPSILANTI MI
48197-1004
US

IV. Provider business mailing address

5333 MCAULEY DR RM 6106
YPSILANTI MI
48197-1005
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-2492
  • Fax: 734-712-5465
Mailing address:
  • Phone: 734-712-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW F. NAVARRE
Title or Position: REGIONAL MANAGER RETAIL PHARMACY
Credential: PHARM-D
Phone: 734-712-3333