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Contact Information

ST JOHN PROVIDENCE HEALTH SYSTEM
16001 W 9 MILE RD
SOUTHFIELD, MI48075-4818
 Phone: 248-849-3000
 Fax: 248-849-2244
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Adult Health

363LA2200X 50 Nurse Practitioner
 

Diabetes Educator

163WD0400X
 

Nursing Care

251J00000X
Indicates primary specialty

NPI Profile & details for ST JOHN PROVIDENCE HEALTH SYSTEM · (Female)

NPI Number 1922063213
Status Active
Credentials
Entity Individual
Enumeration date 04/19/2006
Last updated 02/16/2026 - About 4 months ago
Sole proprietor 1 Not specified
Identifiers
  • MI Other 110F364771 MI BLUE CROSS GOUP PIN #
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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