# UNIVERSITY INTERNAL MEDICINE SPECIALISTS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265566574
- **Authorized official:** JILL G. MOORE (ADMINISTRATOR)
- **Authorized official phone:** (313) 745-8212

## Contact information

- **Practice address:** 4100 JOHN R ST, DETROIT, MI 48201-2013
- **Practice address phone:** (313) 745-4525
- **Mailing address:** 3800 WOODWARD AVE., SUITE 600, DETROIT, MI 48201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0H24940 | BCBSM GROUP NUMBER | MI |