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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