Organization
ST JOHN HEALTH SYSTEM
Active
Organization
ST JOHN HEALTH SYSTEM
Active
Other names
St John Health Chronic Headache and MIgraine Institute
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA ELLEN WHITMAN (DIRECTOR-PHYSICIAN BILLING SERVICES)
(248) 746-3218
Entity
Organization
Contact information
Practice address
27483 DEQUINDRE RD, SUITE 306, MADISON HEIGHTS, MI 48071-3491
(248) 967-7988
(248) 967-7991
Mailing address
25925 TELEGRAPH RD, 210, SOUTHFIELD, MI 48034-2518
(248) 746-3218
(248) 746-0369
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680F33073
BCBSM GROUP PIN
MI
Enumeration date
03/30/2007
Last updated
09/11/2025
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