Organization
ST JOHN MACOMB OAKLAND HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDOLPH KUMMLER (VP FINANCE)
(586) 573-5910
Entity
Organization
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5000
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0275
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300E011130
BLUE CROSS
MI
Enumeration date
05/20/2008
Last updated
05/20/2008
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