Organization
ST JOSEPH MERCY HOSPITAL
Active
Organization
ST JOSEPH MERCY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P GUSHO (CFO SE MI REGION)
(248) 858-6174
Entity
Organization
Contact information
Practice address
2200 N CANTON CENTER RD, SUITE 200B, CANTON, MI 48187-5065
(734) 981-3800
Mailing address
34505 W 12 MILE RD STE 200, FARMINGTON HILLS, MI 48331-3286
(734) 343-3922
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10434
BLUE CROSS
MI
Enumeration date
05/10/2007
Last updated
10/05/2017
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