Organization
SUMMIT OF DETROIT, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANISE L BURRELL (ADMINISTRATOR)
(313) 272-8450
Entity
Organization
Contact information
Practice address
15801 W MCNICHOLS, DETROIT, MI 48235-3543
(313) 272-8450
(313) 272-8455
Mailing address
15801 W MCNICHOLS, DETROIT, MI 48235-3543
(313) 272-8450
(313) 272-8455
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801072558
MI
133V00000X
Registered Dietitian
861501
MI
163W00000X
Registered Nurse
4704191117
MI
207V00000X
Obstetrics & Gynecology Physician
4301028327
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
4301030345
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160Q260450
BCBSM
MI
01
—
3802006439
EIN
MI
01
—
4404690
STATE OF MI MEDICAID
MI
Enumeration date
02/26/2007
Last updated
01/03/2012
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