MEDICARE: CITY OF DETROIT

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	251K00000X	Public Health or Welfare Agency
2	163WC1500X	Community Health Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538342936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF DETROIT

Provider Business Mailing Address
First Line	:	1151 TAYLOR ST
Second Line	:	BUIDING #6
City	:	DETROIT
State	:	MI
Zip	:	48202-1732
Country	:	US
Telephone Number	:	313-876-4161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3245 E JEFFERSON AVE STE 100
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4222
Country	:	US
Telephone Number	:	313-876-4000
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JONEIGH KHALDUN
Credential	:	MD
Telephone Number	:	313-876-4000

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	07/21/2022

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Directions to “CITY OF DETROIT ” Practice Location

Language	Start Address	Practice Location

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