Organization
UNIVERSITY PHYSICIAN GROUP
Active
Other names
Wayne State University Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY P KOHLITZ (CHIEF FINANCIAL OFFICER)
(248) 581-5930
Entity
Organization
Contact information
Practice address
26400 W 12 MILE RD, SUITE 60, SOUTHFIELD, MI 48034-1774
(248) 594-6702
(248) 594-6738
Mailing address
1560 E. MAPLE RD., SUITE 400-CREDENTIALING, TROY, MI 48083-1138
(248) 581-5973
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
4301054761
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5717980008
NGS
MI
Enumeration date
01/27/2016
Last updated
12/01/2016
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up