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General NPI Number Information
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NPI Number | 1013079573
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Entity Type | Organization
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Legal Business Name | BOTSFORD GENERAL HOSPITAL
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 39750 GRAND RIVER AVE ATTN OMM CLINIC
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City | NOVI
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State | MI
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Zip | 48375-2106
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Country | US
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Telephone | 248-477-6100
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Fax | 248-473-8480
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 947-522-1963
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | NANCY SUSICK
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Credential |
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Telephone | 947-522-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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