Provider Demographics
NPI:1710133541
Name:ST JOSEPH MERCY
Entity Type:Organization
Organization Name:ST JOSEPH MERCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:ZUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-345-6813
Mailing Address - Street 1:5053 BANTRY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1531
Mailing Address - Country:US
Mailing Address - Phone:248-345-6813
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088659282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301088659OtherBOARD OF MEDICINE EDUCATIONAL LIMITED LICENSE
MI5315028012OtherBOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE