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General NPI Number Information
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NPI Number | 1225237613
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Entity Type | Organization
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Legal Business Name | SPARROW EATON HOSPITAL
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 111 LANSING ST STE 230
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City | CHARLOTTE
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State | MI
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Zip | 48813-2400
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Country | US
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Telephone | 175-435-1105
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Fax | 517-543-9776
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Provider Business Mailing Address
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Address Line | 8175 RELIABLE PKWY
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City | CHICAGO
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State | IL
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Zip | 60686-0081
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Country | US
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Telephone | 517-253-6320
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Fax | 517-253-6321
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Authorized Official
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Title or Position | SUPERVISOR, PROVIDER ENROLLMENT
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Name | MISTY GUNTER RUSSIAN
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Credential |
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Telephone | 517-253-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 207RX0202X
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Taxonomy Name | Medical Oncology 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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