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Organization
ST JOSEPH MERCY HOSPITAL
Active
Organization
ST JOSEPH MERCY HOSPITAL
Active
Other names
St Joseph Mercy Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
ARIANA GRACE RAYMOND (MANAGER PROVIDER ENROLLMENT)
(734) 343-1466
Entity
Organization
Contact information
Practice address
5301 E HURON RIVER DR, MIXED SPECIALTY PHYSICIAN, NON PHYSICIAN, YPSILANTI, MI 48197-1051
(734) 712-3456
Mailing address
20555 VICTOR PKWY, LIVONIA, MI 48152-7031
(518) 339-6568
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H105090
BLUE SHIELD BCN
MI
01
—
700H161080
BS BCN MX SPEC P, NP
MI
Enumeration date
03/28/2007
Last updated
05/04/2026
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