| Organization Name: | UNIVERSITY PHYSICIAN GROUP |
| NPI Number: | 1336417146 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE K STILLER (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 4100 John R St Karmanos Cancer Center-wertz Clinic Detroit |
| State: | MI US |
| Postal Code: | 482012013 |
| Phone Number: | 8005276266 |
| Fax Number: | 3135768381 |
| NPI Enumeration Date: | 12/07/2011 |
| NPI Last Update Date: | 02/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 4301038094 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |