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Organization
WILLIAM BEAUMONT HOSPITAL
Active
Organization
WILLIAM BEAUMONT HOSPITAL
Active
Other names
BEAUMONT PROFESSIONAL SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 423-2454
(248) 423-2576
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-3849
(947) 522-1964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080F370780
BCBSM
MI
01
—
110F376980
BCBSM
MI
01
—
350F361320
BCBSM
MI
Enumeration date
05/23/2007
Last updated
10/07/2021
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