Provider Demographics
NPI:1710992557
Name:WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:313-745-1540
Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:UHC-8C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-1540
Mailing Address - Fax:313-577-4641
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:UHC-8C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-1540
Practice Address - Fax:313-577-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076212282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital