Organization
PROVIDENCE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY KUMAR MITTAL MD (PROGRAM DIRECTOR)
(248) 849-8902
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-8902
Mailing address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
4301108431
MI
Other
Enumeration date
07/23/2015
Last updated
07/23/2015
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