Provider Demographics
NPI:1346367638
Name:CITY OF DETROIT
Entity type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PUBLIC HEALTH ADVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KANZONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASABIGI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD, MPH, MBA, C
Authorized Official - Phone:313-876-4000
Mailing Address - Street 1:DETROIT HEALTH DEPT-HERMAN KIEFER PHARMACY DIVISION
Mailing Address - Street 2:1151 TAYLOR STREET, ROOM 41 B-WING
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-4018
Mailing Address - Fax:313-876-0512
Practice Address - Street 1:DETROIT HEALTH DEPT-HERMAN KIEFER PHARMACY DIVISION
Practice Address - Street 2:1151 TAYLOR STREET, ROOM 41 B-WING
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4018
Practice Address - Fax:313-876-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301001698332B00000X, 333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2538597Medicaid
MI2323082Medicaid
MI2323082Medicaid