Organization
GRACE UNIVERSITY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH BERGSMAN MD (MANAGER)
(313) 966-4946
Entity
Organization
Contact information
Practice address
6071 W OUTER DR, DEPT OF MEDICINE 4TH FLOOR, DETROIT, MI 48235-2624
(313) 966-4946
Mailing address
PO BOX 321061, DETROIT, MI 48232-1061
(248) 543-8070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RH0003X
Hematology & Oncology Physician
4301028293
MI
Other
Enumeration date
04/20/2006
Last updated
09/19/2007
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