Provider Demographics
NPI:1922249598
Name:DETRIOT MEDICAL CENTER
Entity Type:Organization
Organization Name:DETRIOT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHAD
Authorized Official - Middle Name:MUHSIN
Authorized Official - Last Name:ABDUL-KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-721-1130
Mailing Address - Street 1:80 E HANCOCK ST APT 711
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1331
Mailing Address - Country:US
Mailing Address - Phone:313-721-1130
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1331
Practice Address - Country:US
Practice Address - Phone:313-721-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090446282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital