Organization
ST MARY MERCY HOSPITAL CRNA
Active
Parent organization
ST MARY MERCY HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST MARY MERCY HOSPITAL
Authorized official
MICHAEL GUSHO (CFO)
(248) 763-3575
Entity
Organization
Contact information
Practice address
36475 5 MILE RD, LIVONIA, MI 48154-1971
(734) 655-4800
(734) 655-1274
Mailing address
36475 5 MILE RD, LIVONIA, MI 48154-1971
(734) 655-4800
(734) 655-1274
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430H233570
BLUE SHIELD
MI
Enumeration date
07/26/2007
Last updated
01/06/2025
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