Organization
PROVIDENCE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB JUTA MD (SURGERY RESIDENT PHYSICIAN)
(248) 849-3073
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3073
Mailing address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3073
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
0116017922
VA
282N00000X
General Acute Care Hospital
Primary
4301095168
MI
Other
Enumeration date
06/10/2008
Last updated
07/20/2009
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