Provider Demographics
NPI:1740402114
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:DIRECTOR OF DRUGTREATMENT CITY OF D
Authorized Official - Prefix:DR
Authorized Official - First Name:KANZONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASABIGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-4000
Mailing Address - Street 1:8809 JOHN C LODGE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-887-6737
Mailing Address - Fax:
Practice Address - Street 1:3245 E JEFFERSON AVE STE 100
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:313-876-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820080251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4456991Medicaid