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General NPI Number Information
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NPI Number | 1326279803
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Entity Type | Organization
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Legal Business Name | DETROIT MEDICAL CENTER
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Dates
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Enumeration Date | 08/02/2009
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Last Update Date | 08/02/2009
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Provider Practice Location Address
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Address Line | 39180 CITATION PL APT # 35104
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-4901
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Country | US
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Telephone | 713-657-5012
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Fax |
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Provider Business Mailing Address
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Address Line | 39180 CITATION PL APT # 35104
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-4901
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Country | US
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Telephone | 713-657-5012
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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. KIREETI POTU
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Credential | M.D
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Telephone | 713-657-5012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 4301094041
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License Number State | MI
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