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General NPI Number Information
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NPI Number | 1295016103
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Entity Type | Organization
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Legal Business Name | SINAI GRACE HOSPITAL
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 9358 LOUIS
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City | REDFORD
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State | MI
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Zip | 48239-1746
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Country | US
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Telephone | 313-515-7828
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Fax |
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Provider Business Mailing Address
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Address Line | 9358 LOUIS
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City | REDFORD
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State | MI
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Zip | 48239-1746
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | CARLETA POYDRAS
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Credential | PA-C
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Telephone | 313-515-7828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 363A50400X
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License Number State | MI
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