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General NPI Number Information
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NPI Number | 1730275868
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH MEDICAL CENTER PC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 17950 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48203-2260
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Country | US
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Telephone | 313-867-2300
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Fax | 313-867-0467
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Provider Business Mailing Address
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Address Line | 17950 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48203-2260
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Country | US
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Telephone | 313-867-2300
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Fax | 313-867-0467
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Authorized Official
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Title or Position | OWNER
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Name | ASOK ROY
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Credential | M.D.
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Telephone | 313-867-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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