Provider Demographics
NPI:1427297712
Name:HOSPITALIST & PALLIATIVE MEDICINE
Entity type:Organization
Organization Name:HOSPITALIST & PALLIATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONALI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-3332
Mailing Address - Street 1:18181 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-5032
Mailing Address - Country:US
Mailing Address - Phone:313-271-5565
Mailing Address - Fax:313-563-3342
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-271-5565
Practice Address - Fax:313-563-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H243080OtherBCBS MICHIGAN
MI1427297712Medicaid
MIMI1494Medicare PIN
MIH48635Medicare UPIN