Basic Information
| Provider Information | |||||||||
| NPI: | 1679651871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. JOHN EMERGENCY PHYSICIANS, P. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17717 MASONIC | ||||||||
| Address2: | |||||||||
| City: | FRASER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480263158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005315788 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22101 MOROSS RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133434000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8005315788 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.