Provider Demographics
NPI:1205178761
Name:DETROIT MEDICAL CENTER
Entity Type:Organization
Organization Name:DETROIT MEDICAL CENTER
Other - Org Name:CHILDREN'S HOSPITAL OF MICHIGAN
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KALLOL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-265-5783
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, CHILDREN'S HOSPITAL OF MICHIGA
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-966-5201
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY, CHILDREN'S HOSPITAL OF MICHIGA
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-966-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011007732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty