# WSU PHYSICIAN GROUP

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

## Provider details

- **NPI number:** 1639466055
- **Authorized official:** STEPHANIE WRIGHT (MANAGER HUMAN RESOURCES)
- **Authorized official phone:** (313) 577-8579

## Contact information

- **Practice address:** 4201 ST. ANTOINE - UNIVERSITY HEALTH CENTER, POD 5A, DETROIT, MI 48201
- **Practice address phone:** (313) 745-4008
- **Mailing address:** 4201 ST. ANTOINE - UNIVERSITY HEALTH CENTER, POD- 4H, DETROIT, MI 48201
- **Mailing address phone:** (313) 577-4984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 4704217349 | MI | Yes |

## Other

- **Enumeration date:** 07/06/2011
- **Last updated:** 07/06/2011