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General NPI Number Information
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NPI Number | 1740382183
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Entity Type | Organization
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Legal Business Name | SJMH MEDICAL PRACTICE
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44555 WOODWARD AVE SUITE 105
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City | PONTIAC
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State | MI
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Zip | 48341-5031
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Country | US
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Telephone | 248-858-6773
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Fax | 248-858-3921
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Provider Business Mailing Address
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Address Line | 44428 WOODWARD AVE LOWER LEVEL
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City | PONTIAC
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State | MI
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Zip | 48341-5009
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Country | US
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Telephone | 248-858-6144
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Fax | 248-858-6232
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Authorized Official
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Title or Position | CEO
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Name | JACK WEINER
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Credential |
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Telephone | 248-858-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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