Provider Demographics
NPI:1336661156
Name:INSTITUTE FOR POPULATION HEALTH INC.
Entity Type:Organization
Organization Name:INSTITUTE FOR POPULATION HEALTH INC.
Other - Org Name:WOODWARD
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-309-9350
Mailing Address - Street 1:19830 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1910
Mailing Address - Country:US
Mailing Address - Phone:313-309-9350
Mailing Address - Fax:313-341-0198
Practice Address - Street 1:9053 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1822
Practice Address - Country:US
Practice Address - Phone:313-309-6707
Practice Address - Fax:313-309-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231117Medicaid