Provider Demographics
NPI:1326279803
Name:DETROIT MEDICAL CENTER
Entity Type:Organization
Organization Name:DETROIT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:KIREETI
Authorized Official - Middle Name:
Authorized Official - Last Name:POTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-657-5012
Mailing Address - Street 1:39180 CITATION PL
Mailing Address - Street 2:APT # 35104
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4901
Mailing Address - Country:US
Mailing Address - Phone:713-657-5012
Mailing Address - Fax:
Practice Address - Street 1:39180 CITATION PL
Practice Address - Street 2:APT # 35104
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-4901
Practice Address - Country:US
Practice Address - Phone:713-657-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094041284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital