| Organization Name: | BOTSFORD GENERAL HOSPITAL |
| NPI Number: | 1013079573 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID MARCELLINO (CFO) |
| Mailing Address: | 39750 Grand River Ave Attn Omm Clinic Novi |
| State: | MI US |
| Postal Code: | 483752106 |
| Phone Number: | 2484776100 |
| Fax Number: | 2484738480 |
| NPI Enumeration Date: | 12/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |