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Organization
ST JOSEPH MERCY HOSPITAL
Active
Organization
ST JOSEPH MERCY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P GUSHO (CFO SE MI REGION)
(248) 858-6174
Entity
Organization
Contact information
Practice address
5333 MCAULEY DRIVE, SUITE 2110, YPSILANTI, MI 48197-1051
(734) 712-4017
Mailing address
34505 W 12 MILE RD STE 200, FARMINGTON HILLS, MI 48331-3286
(734) 343-3922
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
NULL
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7700000001
MI MEDICAID-MATERNAL INFANT HEALTH PROGRAM
MI
Enumeration date
01/26/2009
Last updated
10/05/2017
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