Provider Demographics
NPI:1336182351
Name:DETROIT OSTEOPATHIC HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:DETROIT OSTEOPATHIC HOSPITAL CORPORATION
Other - Org Name:HENRY FORD MACOMB HOSPITAL - WARREN CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:POPIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-759-7500
Mailing Address - Street 1:13355 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2048
Mailing Address - Country:US
Mailing Address - Phone:586-759-7480
Mailing Address - Fax:586-759-7479
Practice Address - Street 1:13355 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:586-759-7480
Practice Address - Fax:586-759-7479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DETROIT OSTEOPATHIC HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINC0003776OtherMCARE
MI610522900OtherUSDOL
MI430E062130OtherBCBS
MI7058051OtherAETNA
MI7058051OtherAETNA
MI430E062130OtherBCBS