Organization
ST JOHN HOSPITAL AND MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN FIELD (SR DIRECTOR)
(586) 753-0011
Entity
Organization
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(586) 753-0011
Mailing address
28800 DEQUINDRE RD, WARREN, MI 48092-2466
(586) 753-0011
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0866958
BLUE CROSS
—
Enumeration date
02/24/2009
Last updated
02/24/2009
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