# GRACE UNIVERSITY MEDICAL GROUP

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

## Provider details

- **NPI number:** 1447215538
- **Authorized official:** KENNETH BERGSMAN MD (MANAGER)
- **Authorized official phone:** (313) 966-4946

## Contact information

- **Practice address:** 6071 W OUTER DR, DEPT OF MEDICINE 4TH FLOOR, DETROIT, MI 48235-2624
- **Practice address phone:** (313) 966-4946
- **Mailing address:** PO BOX 321061, DETROIT, MI 48232-1061
- **Mailing address phone:** (248) 543-8070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RH0003X | Hematology & Oncology Physician | 4301028293 | MI | — |

## Other

- **Enumeration date:** 04/20/2006
- **Last updated:** 09/19/2007