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General NPI Number Information
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NPI Number | 1578502845
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Entity Type | Organization
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Legal Business Name | UNIVERSITY INTERNAL MEDICINE SPECIALISTS
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4201 ST. ANTOINE SUITE 5A
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-745-4525
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 WOODWARD AVE. SUITE 702
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City | DETROIT
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State | MI
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Zip | 48201
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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 | ADMINISTRATOR
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Name | JILL G. MOORE
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Credential |
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Telephone | 313-745-8212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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