Provider Demographics
NPI:1346570926
Name:SINAI GRACE OF GREATER DETROIT
Entity Type:Organization
Organization Name:SINAI GRACE OF GREATER DETROIT
Other - Org Name:ANGELA PORTER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-557-0507
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5360
Mailing Address - Country:US
Mailing Address - Phone:248-557-0480
Mailing Address - Fax:
Practice Address - Street 1:20905 GREENFIELD RD
Practice Address - Street 2:SUITE 406
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5360
Practice Address - Country:US
Practice Address - Phone:248-557-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty