Organization
ST. JOHN PROVIDENCE MACOMB/OAKLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BAL K GUPTA M.D. (DIRECTOR OF BEHAVIORIAL MEDICINE)
(586) 573-5300
Entity
Organization
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(585) 573-5300
Mailing address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(585) 573-5300
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
6401002292
MI
283Q00000X
Psychiatric Hospital
Primary
6802070800
MI
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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