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Organization

WILLIAM BEAUMONT HOSPITAL

Active
Parent organization
WILLIAM BEAUMONT HOSPITAL
Other names
Beaumont Professional Services/Thoracic Surgery
Organization subpart
Yes

Provider details

NPI number
Legal business name
WILLIAM BEAUMONT HOSPITAL
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization

Contact information

Practice address
3601 W 13 MILE RD, 400 FSC-PCS, ROYAL OAK, MI 48073-6712
(248) 423-3754
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-3849
(947) 522-1964

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0F36108
BCBSM GROUP
MI
Enumeration date
05/06/2006
Last updated
10/01/2021
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