Organization
WILLIAM BEAUMONT HOSPITAL
Active
Parent organization
WILLILAM BEAUMONT HOSPITAL
Other names
BEAUMONT PROFESSIONAL SERVICES/GERIATRICS
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILLILAM BEAUMONT HOSPITAL
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 423-2454
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-3849
(947) 522-1964
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110F376980
BCBSM
MI
Enumeration date
05/09/2006
Last updated
10/01/2021
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