Organization
INSTITUTE FOR POPULATION HEALTH INC.
Active
Other names
School Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY WILLIAMSON (REVENUE MANAGER)
(313) 309-9350
Entity
Organization
Contact information
Practice address
15491 MADDELEIN ST, DETROIT, MI 48205-2596
(313) 309-9350
(313) 309-5060
Mailing address
15491 MADDELEIN ST, DETROIT, MI 48205-2596
(313) 309-9350
(313) 309-5060
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231117
—
MI
01
—
71020000H28082
BLUE CROSS
MI
Enumeration date
03/07/2019
Last updated
12/12/2023
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