Organization
WAYNE STATE UNIVERSITY
Active
Other names
University Physicians Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALIREZA AMIRSADRI M.D. (CHIEF MEDICAL OFFICER)
(313) 319-3973
Entity
Organization
Contact information
Practice address
3901 CHRYSLER SERVICES DRIVE, DETROIT, MI 48201
(313) 993-3434
Mailing address
18 STABLE GATE RD, HILTON HEAD ISLAND, SC 29926-1059
(478) 258-6378
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
4704104646
MI
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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