Organization
ST JOHN MACOMB OAKLAND HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDOLPH KRUMMLER (VP FINANCE)
(586) 573-5910
Entity
Organization
Contact information
Practice address
7733 E JEFFERSON AVE, DETROIT, MI 48214-3707
(313) 499-4000
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0275
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26326
BLUE CROSS
—
01
—
18200032
BLUE CROSS
MI
Enumeration date
05/21/2008
Last updated
06/25/2008
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