Provider Demographics
NPI:1245564889
Name:CHILDREN'S HOSPITAL OF MICHIGAN
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL OF MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-745-0633
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-0633
Mailing Address - Fax:
Practice Address - Street 1:42700 GARFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4201
Practice Address - Country:US
Practice Address - Phone:586-532-3401
Practice Address - Fax:586-416-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care