Healthcare Provider Details

I. General information

NPI: 1841564788
Provider Name (Legal Business Name): HENRY FORD WYANDOTTE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7226 ALLEN RD
ALLEN PARK MI
48101-2060
US

IV. Provider business mailing address

1640 FORT ST STE D
TRENTON MI
48183-2040
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-5530
  • Fax: 313-383-1003
Mailing address:
  • Phone: 734-391-3057
  • Fax: 734-391-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK SMITH
Title or Position: SVP
Credential: MD
Phone: 517-205-6407