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Organization
PROVIDENCE HOSPITAL
Active
Organization
PROVIDENCE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY MITTAL (PROGRAM DIRECTOR)
(248) 849-3073
Entity
Organization
Contact information
Practice address
10508 KEANE DR, GRASS LAKE, MI 49240-8803
(517) 522-4451
Mailing address
16001 WEST 9 MILE ROAD, DEPARTMENT OF GENERAL SURGERY, SOUTHFIELD, MI 48075
(248) 849-3073
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
L952723
MI
Other
Enumeration date
04/17/2007
Last updated
08/22/2020
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