Basic Information
| Provider Information | |||||||||
| NPI: | 1427297712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITALIST & PALLIATIVE MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18181 OAKWOOD BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481245032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132715565 | ||||||||
| FaxNumber: | 3135633342 | ||||||||
| Practice Location | |||||||||
| Address1: | 18181 OAKWOOD BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481245032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132715565 | ||||||||
| FaxNumber: | 3135633342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILBORN | ||||||||
| AuthorizedOfficialFirstName: | SONALI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3135633332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 110H243080 | 01 | MI | BCBS MICHIGAN | OTHER | 1427297712 | 05 | MI | MEDICAID |