Provider Demographics
NPI:1760701262
Name:CITY OF DETROIT
Entity Type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER, COMMUNITY HEALTH
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:313-876-4000
Mailing Address - Street 1:1151 TAYLOR ST
Mailing Address - Street 2:323 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:313-876-0475
Practice Address - Street 1:1151 TAYLOR ST
Practice Address - Street 2:323 C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4307
Practice Address - Fax:313-876-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI445991Medicaid