Provider Demographics
NPI:1033429394
Name:CITY OF DETROIT
Entity Type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:DETROIT HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-348-2883
Mailing Address - Street 1:100 MACK AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2416
Mailing Address - Country:US
Mailing Address - Phone:313-876-0349
Mailing Address - Fax:313-877-9305
Practice Address - Street 1:100 MACK AVE FL 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2416
Practice Address - Country:US
Practice Address - Phone:313-480-3831
Practice Address - Fax:313-877-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4456991Medicaid