Basic Information
| Provider Information | |||||||||
| NPI: | 1033270426 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST JOHN HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2251 ST CLAIR AVE | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | ON | ||||||||
| PostalCode: | N9B3W4 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 5199721716 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4777 E OUTER DR | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482343241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133695689 | ||||||||
| FaxNumber: | 3133695688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HERRERA | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3133188804 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 5601004646 | MI | Y | Hospitals | General Acute Care Hospital |
No ID Information.