MEDICARE: BOTSFORD GENERAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G4732F	OTHER	MI	BCN
2	350F378030	OTHER	MI	BLUE CROSS

General Provider Information

NPI Number	:	1437191947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOTSFORD GENERAL HOSPITAL

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23133 ORCHARD LAKE RD
Second Line	:	SUITE 100
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3268
Country	:	US
Telephone Number	:	248-477-0100
Fax Number	:	248-477-6153

Authorized Official
Title or Position	:	DIRECTOR SHARED SERVICES
Name	:	LESLEY WILLBRANDT
Credential	:
Telephone Number	:	947-522-1911

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/16/2019

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Directions to “BOTSFORD GENERAL HOSPITAL ” Practice Location

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