# ST JOHN HEALTH SYSTEM OAKLAND

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

## Provider details

- **NPI number:** 1366470908
- **Authorized official:** EVETTE N ELSENETY MD (DIRECTOR OF PATHOLOGY)
- **Authorized official phone:** (248) 967-7750

## Contact information

- **Practice address:** 27351 DEQUINDRE, MADISON HEIGHTS, MI 48071-3487
- **Practice address phone:** (248) 967-7750
- **Practice address fax:** (248) 967-7297
- **Mailing address:** PO BOX 673062, DETROIT, MI 48267-3062
- **Mailing address phone:** (248) 967-7750
- **Mailing address fax:** (248) 967-7297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 08/22/2020