Organization
PROVIDENCE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAI KINYELL PALM M.D. (RESIDENT PHYSICIAN)
(313) 622-5004
Entity
Organization
Contact information
Practice address
22250 PROVIDENCE DR, SUITE 500, SOUTHFIELD, MI 48075-4825
(248) 849-3447
(248) 849-5389
Mailing address
11692 BEAVERLAND, DETROIT, MI 48239-1357
(313) 622-5004
(248) 849-5389
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
4301094326
MI
261QP2300X
Primary Care Clinic/Center
4301094326
MI
282N00000X
General Acute Care Hospital
Primary
4301094326
MI
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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