Provider Demographics
NPI:1881633022
Name:SINAI HOSPITAL OF GREATER DETROIT
Entity Type:Organization
Organization Name:SINAI HOSPITAL OF GREATER DETROIT
Other - Org Name:SINAI GRACE PHYSICIANS ASSISTANTS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:STAVALE
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:313-440-4479
Mailing Address - Street 1:6071 W OUTER DR
Mailing Address - Street 2:SINAI GRACE PHYSICIANS ASSISTANT GROUP
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2624
Mailing Address - Country:US
Mailing Address - Phone:313-966-3300
Mailing Address - Fax:810-765-8169
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:SINAI GRACE PHYSICIANS ASSISTANT GROUP
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:313-966-3300
Practice Address - Fax:810-765-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty