Provider Demographics
NPI:1881130714
Name:TRINITY HEALTH - MICHIGAN
Entity type:Organization
Organization Name:TRINITY HEALTH - MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-398-0642
Mailing Address - Street 1:7575 GRAND RIVER RD
Mailing Address - Street 2:ROOM 212
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9309
Mailing Address - Country:US
Mailing Address - Phone:810-844-7645
Mailing Address - Fax:810-844-7222
Practice Address - Street 1:7575 GRAND RIVER RD RM 212
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9309
Practice Address - Country:US
Practice Address - Phone:810-844-7645
Practice Address - Fax:810-844-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010094353336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166861OtherPK