Organization
PROVIDENCE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY G OTSUJI M.D. (PROGRAMDIRECTOR)
(248) 849-3447
Entity
Organization
Contact information
Practice address
16400 N PARK DR APT 1008, SOUTHFIELD, MI 48075-4728
(248) 835-7259
Mailing address
16400 N.PARK DRIVE APT.1008, SOUTHFIELD, MI 48075
(248) 835-7259
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
—
—
Other
Enumeration date
06/28/2007
Last updated
08/22/2020
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