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General NPI Number Information
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NPI Number | 1154423598
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Entity Type | Organization
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Legal Business Name | SJMH MEDICAL PRACTICE
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 44405 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-858-3526
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Fax | 248-858-6232
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Provider Business Mailing Address
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Address Line | 44405 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-858-3526
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Fax | 248-858-6232
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Authorized Official
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Title or Position | CEO
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Name | JACK WEINER
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Credential |
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Telephone | 248-858-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number |
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License Number State |
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