Provider Demographics
NPI:1033328117
Name:ST. JOHN HOSPITAL & MEDICAL CENTER
Entity type:Organization
Organization Name:ST. JOHN HOSPITAL & MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MEDICAL EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-343-3823
Mailing Address - Street 1:19251 MACK AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2893
Mailing Address - Country:US
Mailing Address - Phone:313-343-3802
Mailing Address - Fax:313-343-7840
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:SUITE 50
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-7774
Practice Address - Fax:313-343-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081630282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital