| Wayne State University Physician Group | |
|
3901 Chrysler Dr Tolan Park Detroit MI 48201-2167 | |
| (313) 993-3434 | |
| (313) 993-3421 |
| Full Name | Wayne State University Physician Group |
|---|---|
| Speciality | Counselor |
| Location | 3901 Chrysler Dr, Detroit, Michigan |
| Authorized Official Name and Position | Jeffery P Kohlitz (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2485815930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne State University Physician Group 1560 E Maple Rd Ste 400-credentialing Dept. Troy MI 48083-1138 Ph: (248) 581-5973 | Wayne State University Physician Group 3901 Chrysler Dr Tolan Park Detroit MI 48201-2167 Ph: (313) 993-3434 |
| NPI Number | 1447465661 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 10/26/2016 |
| Medicare PECOS PAC ID | 8628087681 |
|---|---|
| Medicare Enrollment ID | O20200901003086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447465661 | NPI | - | NPPES |
| 0P32060 | Other | MI | MEDICARE GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST |
| 0H22872 | Other | MI | BCBSM GROUP#-SOCIAL WORKER |
| 0H22872 | Other | MI | BCBSM GROUP # - SOCIAL WORKER |
| 0P32180 | Other | MI | MEDICARE GROUP # - NP |
| 0P32050 | Other | MI | MEDICARE GROUP # - SOCIAL WORKER |
| 0H22874 | Other | MI | BCBSM GROUP # - PSYCHOLOGIST/NEUROPSYCHOLOGIST |
| 0H22830 | Other | MI | BCBSM GROUP # - NP |
| 0H22832 | Other | MI | BCBSM GROUP # - MD/DO |
| 0P30630 | Other | MI | MEDICARE GROUP # - MD/DO |
| 0P32120 | Other | MI | MEDICARE GROUP # - MD/DO FEE LOCALITY 99 |
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