1750510756 NPI number — DETROIT MEDICAL CENTER/SINAI GRACE

Table of content: (NPI 1750510756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750510756 NPI number — DETROIT MEDICAL CENTER/SINAI GRACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DETROIT MEDICAL CENTER/SINAI GRACE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750510756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26285 BERG RD
Provider Second Line Business Mailing Address:
APT 276
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48033-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-449-7205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 SAINT ANTOINE ST
Provider Second Line Business Practice Location Address:
9C UHC
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-966-0515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
DEVAUGHN
Authorized Official Title or Position:
INTERN
Authorized Official Telephone Number:
810-449-7205

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  L1594590 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com