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Organization
MERCY MEMORIAL HOSPITAL CORPORATION
Active
Organization
MERCY MEMORIAL HOSPITAL CORPORATION
Active
Parent organization
MERCY MEMORIAL OB SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY MEMORIAL OB SERVICES
Authorized official
KIANOUSH KHAGHNAY MD (GROUP REP)
(734) 240-1442
Entity
Organization
Contact information
Practice address
718 N MACOMB ST, MONROE, MI 48162-7815
(734) 240-1440
(734) 240-1550
Mailing address
718 N MACOMB ST, MONROE, MI 48162-7815
(734) 240-1440
(734) 240-1550
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
NULL
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E81076
BLUE CROSS
MI
Enumeration date
01/31/2008
Last updated
01/31/2008
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