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General NPI Number Information
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NPI Number | 1376654459
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Entity Type | Organization
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Legal Business Name | SJMH MEDICAL PRACTICE
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1812 S ROCHESTER RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-3532
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Country | US
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Telephone | 248-656-9100
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Fax | 248-656-9157
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Provider Business Mailing Address
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Address Line | 1812 S ROCHESTER RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-3532
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Country | US
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Telephone | 248-656-9100
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Fax | 248-656-9157
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Authorized Official
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Title or Position | CEO
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Name | JACK WEINER
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Credential |
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Telephone | 248-858-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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