MEDICARE: CITY OF GROSSE POINTE PARK

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	341600000X	Ambulance	821011	MI

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	:	1780623660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF GROSSE POINTE PARK

Provider Business Mailing Address
First Line	:	15115 E JEFFERSON AVE
Second Line	:
City	:	GROSSE POINTE PARK
State	:	MI
Zip	:	48230-1312
Country	:	US
Telephone Number	:	313-822-7400
Fax Number	:	313-822-4543

Provider Business Practice Location Address
First Line	:	15115 E JEFFERSON AVE
Second Line	:
City	:	GROSSE POINTE PARK
State	:	MI
Zip	:	48230-1312
Country	:	US
Telephone Number	:	313-822-7400
Fax Number	:	313-822-4543

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. DAVID HILLER
Credential	:
Telephone Number	:	313-822-4416

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/17/2008

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Directions to “CITY OF GROSSE POINTE PARK ” Practice Location

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