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General NPI Number Information
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NPI Number | 1679380828
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Entity Type | Organization
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Legal Business Name | DETROIT WAYNE INTEGRATED HEALTH NETWORK
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 707 W MILWAUKEE ST
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City | DETROIT
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State | MI
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Zip | 48202-2943
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Country | US
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Telephone | 313-955-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 11501 PETOSKEY AVE APT 328
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City | DETROIT
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State | MI
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Zip | 48204-3920
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Country | US
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Telephone | 313-955-1500
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Fax |
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Authorized Official
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Title or Position | PEER SUPPORT
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Name | MS. CHRISRANDRA A TAYLOR
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Credential |
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Telephone | 313-955-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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