Provider Demographics
NPI:1508010760
Name:CHILDREN HOSPTIAL OF MICHIGAN
Entity Type:Organization
Organization Name:CHILDREN HOSPTIAL OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC CARDIOLOGY FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:JIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-301-1386
Mailing Address - Street 1:3737 BEAUBIEN ST APT 805
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2152
Mailing Address - Country:US
Mailing Address - Phone:917-301-1386
Mailing Address - Fax:
Practice Address - Street 1:3737 BEAUBIEN ST APT 805
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2152
Practice Address - Country:US
Practice Address - Phone:917-301-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1335110282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren