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General NPI Number Information
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NPI Number | 1275762106
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Entity Type | Organization
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Legal Business Name | ST.JOHN HOSPITAL & MEDICAL CENTER
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 19251 MACK AVE STE 335
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-2895
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Country | US
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Telephone | 312-823-7637
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Fax |
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Provider Business Mailing Address
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Address Line | 19251 MACK AVE STE 335
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-2895
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Country | US
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Telephone | 312-823-7637
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Fax |
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Authorized Official
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Title or Position | RESIDENT
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Name | MONA ABDULLAH ALFARES
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Credential | M.D.
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Telephone | 312-823-7637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | L1598766
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License Number State | MI
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