Organization
ST. JOHN MACOMB-OAKLAND HOSPITAL
Active
Other names
Oculoplastic, Orbital & Neuro-Ophthalmic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JOHNSON (DIRECTOR)
(586) 228-4560
Entity
Organization
Contact information
Practice address
27450 SCHOENHERR RD, SUITE 200, WARREN, MI 48088-6683
(586) 582-7860
(586) 582-7861
Mailing address
27450 SCHOENHERR RD, SUITE 200, WARREN, MI 48088-6683
(586) 582-7860
(586) 582-7861
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
208200000X
Plastic Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180E01180
BCBS GROUP
MI
Enumeration date
09/14/2010
Last updated
09/14/2010
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