PROVIDENCE-PROVIDENCE PARK HOSPITAL NPI 1003871062

Pediatrics (Neonatal-Perinatal Medicine) in Southfield, MI

About PROVIDENCE-PROVIDENCE PARK HOSPITAL

Providence-providence Park Hospital is a provider in Southfield, MI. The NPI number assigned to this provider is 1003871062. The practitioner's primary taxonomy code is Pediatrics (2080N0001X). The provider is registered as an organization and their NPI record was last updated one year ago. Providence-providence Park Hospital operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's other name is Ph Neonatology/providence Hosptial And Medical Centers Inc.

NPI1003871062 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NamePROVIDENCE-PROVIDENCE PARK HOSPITAL
Provider Location Address16001 W 9 MILE RD SOUTHFIELD, MI 48075 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address43750 GARFIELD RD 211 CLINTON TWP, MI 48038 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Other Organization NamePH NEONATOLOGY/PROVIDENCE HOSPTIAL AND MEDICAL CENTERS INC Additional informationCallout TooltipProvider other organization name
The alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. Codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Other Name TypeOther Name (5)
Enumeration Date04-20-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date08-25-2016 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

PROVIDENCE-PROVIDENCE PARK HOSPITAL
16001 W 9 MILE RD
SOUTHFIELD, MI
ZIP 48075
Phone: (248) 849-3000
Fax: (248) 849-2244
Get Directions

Mailing Address

PROVIDENCE-PROVIDENCE PARK HOSPITAL
43750 GARFIELD RD
211
CLINTON TWP, MI
ZIP 48038
Phone: (586) 228-4550
Fax: (586) 226-6962

Primary Taxonomy

Taxonomy Code2080N0001X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationPediatrics
TypeAllopathic & Osteopathic Physicians
SpecializationNeonatal-Perinatal Medicine
Taxonomy DescriptionA pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.

Authorized Official

Authorized Official Name JENNIFER JOHNSON Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleDIRECTOR, CENTRAL BILLING OFFICE
Authorized Official Phone(586) 228-4560

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
350F360230OTHER (01)MI
0F36023MEDICARE PIN (08)MI

Map Location


PROVIDENCE-PROVIDENCE PARK HOSPITAL address is 16001 W 9 MILE RD SOUTHFIELD, MI 48075

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1013919950 CYNTHIA ARCHER-GIFT RN, NP
Individual
Registered Nurse16001 W 9 MILE RD DEPT OF BEHAVORIAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3306
1033118690 TIMOTHY MERVAK MD
Individual
Pathology (Anatomic Pathology & Clinical Pathology)16001 W 9 MILE RD DEPT OF PATHOLOGY
SOUTHFIELD, MI 48075
(248) 849-3270
1093713919MS. LAURIE WATT PA
Individual
16001 W 9 MILE RD
SOUTHFIELD, MI 48075
(248) 849-3856
1215939160 MELANIE BROOKS BRYANT MSW
Individual
Social Worker16001 W 9 MILE RD DEPT OF BEHAVORIAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3306
1235136557 BRENDA J BAKER PHD
Individual
Psychologist (Forensic)16001 W 9 MILE RD 5TH FLOOR FISHER CENTER
SOUTHFIELD, MI 48075
(248) 849-3306
1255336327 JOANNE RUTH DIETZ NP
Individual
Registered Nurse (Neonatal Intensive Care)16001 W 9 MILE RD
SOUTHFIELD, MI 48075
(248) 746-3218
1356342620 KRISTIN MARIE RICE MSN, APRN-BC
Individual
Nurse Practitioner (Adult Health)16001 W 9 MILE RD
SOUTHFIELD, MI 48075
(248) 849-3688
1417956855 PADMINI KEPUL NAYAK MD
Individual
Pathology (Anatomic Pathology & Clinical Pathology)16001 W 9 MILE RD DEPT OF PATHOLOGY
SOUTHFIELD, MI 48075
(248) 849-3000
1518969443 GABRIELA ZAMORA-AHLSTROM MSW
Individual
Social Worker16001 W 9 MILE RD DEPT OF BEHAVORIAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3306
1548268626 JOHN GLEN FROWNFELTER MD
Individual
Internal Medicine16001 W 9 MILE RD DEPT OF INTERNAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3152
1568466498MS. KAREN E GRAY MSN, RN, CS, ONC
Individual
Nurse Practitioner (Adult Health)16001 W 9 MILE RD
SOUTHFIELD, MI 48075
(248) 849-8807
1578562138 STEVEN FRANKLIN MILES MD
Individual
Internal Medicine (Critical Care Medicine)16001 W 9 MILE RD DEPT OF CRITICAL CARE
SOUTHFIELD, MI 48075
(248) 849-3000
1679577415 MYRNA S DELEON MD
Individual
Pediatrics (Pediatric Critical Care Medicine)16001 W 9 MILE RD
SOUTHFIELD, MI 48075
(248) 849-3000
1750383592 MARGARET HAZEL DUTKA MA
Individual
Registered Nurse16001 W 9 MILE RD DEPT OF BEHAVIORAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3000
1760480826 DEBRA HOLLANDER MD
Individual
Psychiatry & Neurology (Psychiatry)16001 W 9 MILE RD DEPT OF BEHAVORIAL MEDICINE
SOUTHFIELD, MI 48075
(248) 746-3218
1760481329 GERRI THOMAS MCAFEE MA,LPC
Individual
Counselor (Mental Health)16001 W 9 MILE RD DEPT OF BEHAVIORAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3301
1881694925 SWARAJYALXMI BURUGUPALLI RAO MD
Individual
Pediatrics (Neonatal-Perinatal Medicine)16001 W 9 MILE RD DEPT OF NEONATOLOGY
SOUTHFIELD, MI 48075
(248) 849-3000
1932108107 SUDHA NARANG MD
Individual
Pathology (Anatomic Pathology & Clinical Pathology)16001 W 9 MILE RD DEPT OF PATHOLOGY
SOUTHFIELD, MI 48075
(248) 849-3000
1982606828 JOAN BEST MSW
Individual
Social Worker16001 W 9 MILE RD DEPT OF BEHAVORIAL MEDICINE
SOUTHFIELD, MI 48075
(248) 849-3306
1992704167 ROGER ONG PA
Individual
Physician Assistant (Surgical Technologist)16001 W 9 MILE RD DEPT OF SURGERY
SOUTHFIELD, MI 48075
(248) 849-3000