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General NPI Number Information
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NPI Number | 1053462846
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Entity Type | Organization
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Legal Business Name | CASCOR HEALTH SYSTEMS PC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 4821 MCNICHOLS ST
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City | DETROIT
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State | MI
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Zip | 48212-1730
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Country | US
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Telephone | 313-368-4600
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Fax | 313-368-4700
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Provider Business Mailing Address
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Address Line | 4821 MCNICHOLS ST
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City | DETROIT
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State | MI
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Zip | 48212-1730
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Country | US
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Telephone | 313-368-4600
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Fax | 313-368-4700
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Authorized Official
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Title or Position | CEO
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Name | DR. SAI WENTUM
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Credential | M.D.
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Telephone | 313-368-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 049430
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License Number State | MI
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