# BOTSFORD GENERAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Botsford Hospital OMM TRACC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013079573
- **Authorized official:** NANCY SUSICK (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (947) 522-3338

## Contact information

- **Practice address:** 39750 GRAND RIVER AVE, ATTN OMM CLINIC, NOVI, MI 48375-2106
- **Practice address phone:** (248) 477-6100
- **Practice address fax:** (248) 473-8480
- **Mailing address:** 26901 BEAUMONT BLVD, SOUTHFIELD, MI 48033-3849
- **Mailing address phone:** (947) 522-1963

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 05/16/2023