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	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	540H241560	OTHER	MI	BCBS OF MICHIGAN
3	2333	OTHER	MI	HAP

General Provider Information

NPI Number	:	1760457048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	21651 MELROSE AVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-7906
Country	:	US
Telephone Number	:	248-353-2468
Fax Number	:	248-353-4260

Provider Business Practice Location Address
First Line	:	7800 W OUTER DR
Second Line	:	STE 104
City	:	DETROIT
State	:	MI
Zip	:	48235-3461
Country	:	US
Telephone Number	:	313-653-2448
Fax Number	:	313-653-2725

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JOHN POLANSKI
Credential	:
Telephone Number	:	248-642-1111

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	09/10/2010

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Directions to “HENRY FORD HEALTH SYSTEM ” Practice Location

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