Organization
ST JOSEPH MERCY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARIANA GRACE RAYMOND (MANAGER PROVIDER ENROLLMENT)
(734) 343-1466
Entity
Organization
Contact information
Practice address
5361 MCAULEY DR, YPSILANTI, MI 48197-1051
(734) 712-5980
Mailing address
34505 W 12 MILE RD STE 200, FARMINGTON HILLS, MI 48331-3286
(734) 343-3922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N20000
MEDICARE
—
01
—
110H111210
BS BCN GERIATRIC SVCS
MI
01
—
110H16181
BS BCN AIM
MI
Enumeration date
03/28/2007
Last updated
05/04/2026
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