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WOODWARD BOULEVARD MEDICAL BUILDING NPI 1689151946


NPI Information

NPI: 1689151946
Provider Name: WOODWARD BOULEVARD MEDICAL BUILDING
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
5830 CONNER ST
DETROIT, MI
ZIP 48213
Phone: (313) 924-1456
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WOODWARD BOULEVARD MEDICAL BUILDING is a clinic center in Detroit, MI. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). WOODWARD BOULEVARD MEDICAL BUILDING NPI is 1689151946. The provider is registered as an organization entity type.

The provider's business location address is:

5830 CONNER ST
DETROIT, MI
ZIP 48213-458
Phone: (313) 924-1456
Fax: (313) 636-2290

The provider's authorized official is Latonya Wallace-hardiman .
The authorized official title is Owner and has the following contact phone number (313) 715-7170.

The enumeration date for this NPI number is 7/19/2018 and was last updated on 11/13/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11053818039OTHERMICHIGANN/A

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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