# UNIVERSITY PHYSICIAN GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wayne State University Physician Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619916418
- **Authorized official:** MR. JEFFERY P KOHLITZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (248) 581-5930

## Contact information

- **Practice address:** 3901 CHRYSLER DR, TOLAN PARK, DETROIT, MI 48201-2167
- **Practice address phone:** (888) 362-7792
- **Practice address fax:** (313) 993-1372
- **Mailing address:** 1560 E MAPLE RD, SUITE 400-CREDENTIALING DEPT., TROY, MI 48083-1138
- **Mailing address phone:** (248) 581-5973
- **Mailing address fax:** (248) 581-5640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | — | NULL | Yes |
| 164W00000X | Licensed Practical Nurse | — | — | Yes |

## Other

- **Enumeration date:** 06/06/2006
- **Last updated:** 10/26/2016