Provider Demographics
NPI:1366921025
Name:INSTITUTE FOR POPULATION HEALTH
Entity type:Organization
Organization Name:INSTITUTE FOR POPULATION HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MAMAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-390-9350
Mailing Address - Street 1:19830 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1910
Mailing Address - Country:US
Mailing Address - Phone:133-309-9350
Mailing Address - Fax:313-309-0198
Practice Address - Street 1:19830 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1910
Practice Address - Country:US
Practice Address - Phone:133-309-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty