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Organization

DETROIT MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CHERYL KELLEY (MANAGER, CREDENTIALING AND ENROLLME)
(313) 993-6080
Entity
Organization

Contact information

Practice address
4201 SAINT ANTOINE ST STE 6A, DRH UNIVERSITY HEALTH CENTER, DETROIT, MI 48201-2153
(313) 745-4230
Mailing address
24131 PRINCETON ST, DEARBORN, MI 48124-3264

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601006086
MI

Other

Enumeration date
10/27/2011
Last updated
10/27/2011
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