MEDICARE: DETROIT MEDICAL CENTER

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1689815300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETROIT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1431 WASHINGTON BLVD
Second Line	:	APT 1814
City	:	DETROIT
State	:	MI
Zip	:	48226-1732
Country	:	US
Telephone Number	:	313-525-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 WASHINGTON BLVD
Second Line	:	APT 1814
City	:	DETROIT
State	:	MI
Zip	:	48226-1732
Country	:	US
Telephone Number	:	313-525-2072
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	DR. JAMES G TYBURSKI
Credential	:	M.D.
Telephone Number	:	313-745-3487

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/07/2023

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Directions to “DETROIT MEDICAL CENTER ” Practice Location

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