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General NPI Number Information
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NPI Number | 1356510085
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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 | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST STE 2E
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-4832
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 SAINT ANTOINE ST STE 2E
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City | DETROIT
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State | MI
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Zip | 48201-2153
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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 | RESIDENT
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Name | NOUREDIN ALEBOUYEH
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Credential | M.D.
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Telephone | 313-974-6157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301090867
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 4301090867
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License Number State | MI
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