Organization
ST JOHN HOSPITAL AND MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER J PALAZZOLO (V.P. - FINANCE)
(313) 343-3558
Entity
Organization
Contact information
Practice address
22201 MOROSS RD, SUITE 70, DETROIT, MI 48236-2169
(586) 753-0011
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0011
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207U00000X
Nuclear Medicine Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Q26016
BCBSM PIN
MI
Enumeration date
03/07/2007
Last updated
06/10/2009
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