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Organization
UNIVERSITY PHYSICIAN GROUP
Active
Organization
UNIVERSITY PHYSICIAN GROUP
Active
Other names
Wayne State University Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY P KOHLITZ (CHIEF FINANCIAL OFFICER)
(248) 581-5930
Entity
Organization
Contact information
Practice address
44000 W 12 MILE RD STE 205, WSUPG PM&R OAKWOOD, NOVI, MI 48377-2647
(248) 465-0100
(248) 465-0107
Mailing address
1560 E. MAPLE RD., SUITE 400 - CREDENTIALING DEPT, TROY, MI 48083-1138
(248) 581-5973
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4301083153
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H70318
BCBSM GROUP#
MI
01
—
0P30630
MEDICARE GROUP #
MI
Enumeration date
10/16/2012
Last updated
10/26/2016
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