Provider Demographics
NPI:1699969782
Name:DETROIT MACOMB-OAKLAND HOSPITAL CORPORATION
Entity type:Organization
Organization Name:DETROIT MACOMB-OAKLAND HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-746-5822
Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-3218
Mailing Address - Fax:248-746-0369
Practice Address - Street 1:11885 E 12 MILE RD
Practice Address - Street 2:300A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3474
Practice Address - Country:US
Practice Address - Phone:586-582-6630
Practice Address - Fax:586-582-6631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DETROIT MACOMB-OAKLAND HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N71840Medicare PIN