| Michigan Department Of Corrections | |
|
17600 Ryan Rd Detroit MI 48212-1155 | |
| (313) 368-3200 | |
| (313) 368-6015 |
| Full Name | Michigan Department Of Corrections |
|---|---|
| Speciality | Public Health Or Welfare |
| Location | 17600 Ryan Rd, Detroit, Michigan |
| Authorized Official Name and Position | Jong Choi (REGIONAL DENTAL DIRECTOR) |
| Authorized Official Contact | 5177805760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Department Of Corrections 17600 Ryan Rd Detroit MI 48212-1155 Ph: (313) 368-3200 | Michigan Department Of Corrections 17600 Ryan Rd Detroit MI 48212-1155 Ph: (313) 368-3200 |
| NPI Number | 1912379751 |
|---|---|
| Provider Enumeration Date | 10/20/2015 |
| Last Update Date | 10/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912379751 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2901014477 (Michigan) | Secondary |
| 251K00000X | Public Health Or Welfare | 2901014477 (Michigan) | Primary |
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