NPIMap

Organization Active NPI

St John Health System- Detroit-Macomb Campus

  • Surgery Physician
  • Warren, MI
National Provider Identifier
1174549018
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ST JOHN HEALTH SYSTEM- DETROIT-MACOMB CAMPUS
Practice address
11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone
(586) 573-5000
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Sandra Whitman
Title
Director
Phone
(586) 226-6823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

11800 E 12 Mile Rd
Warren, MI 48093-3472

Mailing address

43800 Garfield Rd
Suite 200
Clinton Township, MI 48038-1136
Phone (800) 848-0202

Other names 1

  • Macomb Surgical Group Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1174549018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43800 GARFIELD RD",
            "address_2": "SUITE 200",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381136",
            "telephone_number": "800-848-0202",
            "fax_number": "586-226-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933472",
            "telephone_number": "586-573-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN HEALTH SYSTEM- DETROIT-MACOMB CAMPUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "WHITMAN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "586-226-6823",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macomb Surgical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.