Provider Demographics
NPI:1215177019
Name:DETROIT MEDICAL CENTRE
Entity type:Organization
Organization Name:DETROIT MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:VETTESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-745-4832
Mailing Address - Street 1:5000 HEATHER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 HEATHER DRIVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48216
Practice Address - Country:US
Practice Address - Phone:904-316-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital