Organization
BOTSFORD GENERAL HOSPITAL
Active
Other names
Resident OBGYN Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization
Contact information
Practice address
28711 8 MILE RD, SUITE E, LIVONIA, MI 48152-2040
(248) 476-3260
(248) 476-6551
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-3849
(947) 522-1964
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
TRICARE
MI
Enumeration date
08/03/2006
Last updated
10/18/2021
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