NPIMap

Organization Active NPI

Detroit Medical Center

  • Surgical Physician Assistant
  • Detroit, MI
National Provider Identifier
1770869257
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
5601006086 Issued in MI
Legal business name
DETROIT MEDICAL CENTER
Practice address
4201 Saint Antoine St Ste 6a
DRH University Health Center
Detroit, MI 48201-2153
Phone
(313) 745-4230
NPI assigned
Oct 27, 2011
Last updated
Oct 27, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Authorized official

Name
Ms. Cheryl Kelley
Title
Manager, Credentialing and Enrollme
Phone
(313) 993-6080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 5601006086 MI Primary

Addresses

Primary practice location

4201 Saint Antoine St Ste 6a
DRH University Health Center
Detroit, MI 48201-2153

Mailing address

24131 Princeton St
Dearborn, MI 48124-3264

National Provider Directory

National Provider Directory
Tax ID family
Detroit Medical Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4201 Saint Antoine St
Ste 6A
Detroit, MI 48201
Phone (313) 745-4230

NPI Registry JSON

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1770869257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24131 PRINCETON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST STE 6A",
            "address_2": "DRH UNIVERSITY HEALTH CENTER",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-4230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-27",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING AND ENROLLME",
        "authorized_official_telephone_number": "313-993-6080",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601006086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.