Provider Demographics
NPI:1538479019
Name:CITY OF DETROIT
Entity Type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:DETROIT HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANZONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASABIGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-867-4307
Mailing Address - Street 1:1151 TAYLOR ST
Mailing Address - Street 2:111 C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-4307
Mailing Address - Fax:
Practice Address - Street 1:3245 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4222
Practice Address - Country:US
Practice Address - Phone:313-876-4307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI445991Medicaid