Provider Demographics
NPI:1104227719
Name:JOHN D. DINGELL VAMC
Entity type:Organization
Organization Name:JOHN D. DINGELL VAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THEAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-576-3338
Mailing Address - Street 1:4982 CROMWELL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2086
Mailing Address - Country:US
Mailing Address - Phone:586-770-1034
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF VETERAN AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4401004366282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital