| Organization Name: | DIVINE MEDICAL CENTER P C |
| NPI Number: | 1215284583 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CERMEN CARDONA (PRESIDENT) |
| Mailing Address: | 901 W Grand Blvd Detroit |
| State: | MI US |
| Postal Code: | 482082353 |
| Phone Number: | 3133933141 |
| Fax Number: | 3133933144 |
| NPI Enumeration Date: | 08/06/2012 |
| NPI Last Update Date: | 08/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
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Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |