MEDICARE: HENRY FORD HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4301-022010	MI

General Provider Information

NPI Number	:	1174725659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	15401 E JEFFERSON AVE
Second Line	:
City	:	GROSSE POINTE PARK
State	:	MI
Zip	:	48230-1328
Country	:	US
Telephone Number	:	313-824-4800
Fax Number	:	313-824-7080

Provider Business Practice Location Address
First Line	:	15401 E JEFFERSON AVE
Second Line	:
City	:	GROSSE POINTE PARK
State	:	MI
Zip	:	48230-1328
Country	:	US
Telephone Number	:	313-824-4800
Fax Number	:	313-824-7080

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	DR. FREDERICK J. LEPLEY
Credential	:	M.D.
Telephone Number	:	313-824-4800

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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