Organization
ST JOHN MACOMB OAKLAND HOSPITAL
Active
Organization
ST JOHN MACOMB OAKLAND HOSPITAL
Active
Other names
St John Macomb Oakland Hospital Macomb Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDOLPH KUMMLER (V.P. - FINANCE)
(586) 573-5910
Entity
Organization
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5000
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0011
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06262
BCBS PIN
MI
Enumeration date
05/14/2007
Last updated
01/28/2009
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