Provider Demographics
NPI:1346379492
Name:CITY OF DETROIT
Entity type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEP. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KANZONI
Authorized Official - Middle Name:NEUMANN
Authorized Official - Last Name:ASABIGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, MBA
Authorized Official - Phone:313-876-4564
Mailing Address - Street 1:1151 TAYLOR ST RM 319B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-4564
Mailing Address - Fax:
Practice Address - Street 1:1151 TAYLOR ST RM 319B
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822951302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization