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General NPI Number Information
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NPI Number | 1376853937
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Entity Type | Organization
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Legal Business Name | ST JOHN PROVIDENCE HEALTH
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-849-3403
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Fax |
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Provider Business Mailing Address
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Address Line | 16001 W NINE MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-849-3403
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Fax |
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Authorized Official
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Title or Position | RESIDENT PHYSICIAN
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Name | DR. PRADEEP SETTY
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Credential | D.O.
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Telephone | 248-505-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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