Provider Demographics
NPI:1083804173
Name:DETROIT MEDICAL CENTRE
Entity Type:Organization
Organization Name:DETROIT MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIR., GME ADMIN. SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-822-8888
Mailing Address - Street 1:35841 WOODINGTON SQ
Mailing Address - Street 2:APT NO 104
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335
Mailing Address - Country:US
Mailing Address - Phone:904-316-4910
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. ANTOINE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210
Practice Address - Country:US
Practice Address - Phone:313-822-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010902550282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital