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General NPI Number Information
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NPI Number | 1558497008
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Entity Type | Organization
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Legal Business Name | SUMMIT OF DETROIT, P.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 15801 W MCNICHOLS
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City | DETROIT
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State | MI
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Zip | 48235-3543
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Country | US
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Telephone | 313-272-8450
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Fax | 313-272-8455
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Provider Business Mailing Address
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Address Line | 15801 W MCNICHOLS
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City | DETROIT
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State | MI
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Zip | 48235-3543
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Country | US
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Telephone | 313-272-8450
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Fax | 313-272-8455
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANISE L BURRELL
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Credential |
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Telephone | 313-272-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801072558
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 861501
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704191117
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301028327
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301030345
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License Number State | MI
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