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General NPI Number Information
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NPI Number | 1679732085
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Entity Type | Organization
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Legal Business Name | DETROIT MEDICAL CENTER
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 4201 ST ANTOINE
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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 | 313-745-3862
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Fax |
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Provider Business Mailing Address
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Address Line | 4201ST ANTOINE
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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 | M.D
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Name | WILHELMINE WIESE
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Credential |
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Telephone | 313-745-3862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L1127555
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License Number State | MI
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