MEDICARE: HENRY FORD HEALTH RIVER DISTRICT HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207YP0228X	Pediatric Otolaryngology Physician	MI
2	207QA0505X	Adult Medicine Physician	MI
3	207YS0123X	Facial Plastic Surgery Physician	MI
4	207YX0602X	Otolaryngic Allergy Physician	MI
5	207QA0000X	Adolescent Medicine (Family Medicine) Physician	MI
6	207RI0200X	Infectious Disease Physician	MI
7	207Y00000X	Otolaryngology Physician	MI
8	207V00000X	Obstetrics & Gynecology Physician	MI
9	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MI
10	207VX0000X	Obstetrics Physician	MI
11	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	MI
12	207VM0101X	Maternal & Fetal Medicine Physician	MI
13	207VG0400X	Gynecology Physician	MI
14	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	MI
15	207Q00000X	Family Medicine Physician	MI

General Provider Information

NPI Number	:	1265486245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD HEALTH RIVER DISTRICT HOSPITAL

Provider Business Mailing Address
First Line	:	2292 SOLUTION CENTER
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0001
Country	:	US
Telephone Number	:	248-680-8000
Fax Number	:	248-292-3852

Provider Business Practice Location Address
First Line	:	4100 S RIVER RD
Second Line	:
City	:	EAST CHINA
State	:	MI
Zip	:	48054-2909
Country	:	US
Telephone Number	:	800-848-0202
Fax Number	:	586-226-6949

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY CEBALT
Credential	:
Telephone Number	:	313-874-6764

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	04/10/2026

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