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General NPI Number Information
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NPI Number | 1144477035
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Entity Type | Organization
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Legal Business Name | DMC
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-745-5481
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FELLOW
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Name | LIWEN TANG
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Credential |
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Telephone | 313-745-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 4301084603
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License Number State | MI
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