Provider Demographics
NPI:1518159722
Name:THE DETROIT OSTEOPATHIC HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:THE DETROIT OSTEOPATHIC HOSPITAL CORPORATION
Other - Org Name:BI-COUNTY CLINICAL PRACTICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-874-3436
Mailing Address - Street 1:13251 E 10 MILE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2076
Mailing Address - Country:US
Mailing Address - Phone:586-758-6263
Mailing Address - Fax:586-758-7725
Practice Address - Street 1:13251 E 10 MILE RD
Practice Address - Street 2:STE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2076
Practice Address - Country:US
Practice Address - Phone:586-758-6263
Practice Address - Fax:586-758-7725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DETROIT OSTEOPATHIC HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty