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General NPI Number Information
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NPI Number | 1609155951
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Entity Type | Organization
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Legal Business Name | DETROIT MEDICAL CENTER, WAYNE STATE UNIVERSITY, DETROIT, MI
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST
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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 | 313-993-2573
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 SAINT ANTOINE ST
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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 | GRADUATE MEDICAL EDUCATION ASSISTAN
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Name | MISS CONNIE D WILLIAMS
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Credential |
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Telephone | 313-993-2573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State |
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