Provider Demographics
NPI:1447433842
Name:CITY OF DETROIT
Entity type:Organization
Organization Name:CITY OF DETROIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PUBLIC HEALTH ADVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KANZONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASABIGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-4000
Mailing Address - Street 1:5400 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2461
Mailing Address - Country:US
Mailing Address - Phone:313-852-4292
Mailing Address - Fax:
Practice Address - Street 1:3245 E JEFFERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4222
Practice Address - Country:US
Practice Address - Phone:313-876-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI52010062283336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2354330Medicaid