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General NPI Number Information
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NPI Number | 1275676066
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTH MICHIGAN
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 5555 CONNER ST STE 2691
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City | DETROIT
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State | MI
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Zip | 48213-3812
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Country | US
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Telephone | 313-692-8400
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Fax | 313-692-8437
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Provider Business Mailing Address
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Address Line | 5555 CONNER ST SUITE 2691
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City | DETROIT
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State | MI
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Zip | 48213-3448
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Country | US
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Telephone | 313-579-4004
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Fax | 313-267-0057
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. TAWANA MIDDLE NETTLES-ROBINSON
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Credential |
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Telephone | 313-692-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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