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Organization

ST JOHN MACOMB OAKLAND HOSPITAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RANDOLPH KUMMLER (VP 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

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2080P0202X
Pediatric Cardiology Physician
2084N0400X
Neurology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0E061220
BLUE CROSS
Enumeration date
05/20/2008
Last updated
10/16/2008
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