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General NPI Number Information
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NPI Number | 1265665160
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL OF MICHIGAN
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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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 | 313-745-5515
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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 | 313-745-5515
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Fax |
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Authorized Official
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Title or Position | FELLOW
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Name | DR. MOIRA MICHELLE LANCELOT
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Credential | M.D.
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Telephone | 313-745-5515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 4301093680
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License Number State | MI
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