Organization
ST JOHN DETROIT MACOMB HOSPITAL CORPORATION
Active
Other names
St John Weight Loss Center
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA ELLEN WHITMAN (DIRECTOR PBS)
(248) 746-3218
Entity
Organization
Contact information
Practice address
27483 DEQUINDRE RD, 204, MADISON HEIGHTS, MI 48071-3491
(248) 967-7326
(248) 967-7330
Mailing address
25925 TELEGRAPH RD, 210, SOUTHFIELD, MI 48034-2518
(248) 746-3218
(248) 746-0369
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70-0H2015300
BLUE CROSS GROUP PIN
MI
Enumeration date
10/12/2006
Last updated
08/08/2007
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