Provider Demographics
NPI:1497788152
Name:TRINITY MEDICAL CLINIC
Entity Type:Organization
Organization Name:TRINITY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-921-1500
Mailing Address - Street 1:PO BOX 23088
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-0088
Mailing Address - Country:US
Mailing Address - Phone:313-921-1500
Mailing Address - Fax:313-921-4248
Practice Address - Street 1:7737 KERCHEVAL ST
Practice Address - Street 2:SUITE 219
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2437
Practice Address - Country:US
Practice Address - Phone:313-921-1500
Practice Address - Fax:313-921-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty