Healthcare Provider Details

I. General information

NPI: 1568861557
Provider Name (Legal Business Name): HENRY FORD WYANDOTTE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23050 WEST RD STE 240
BROWNSTOWN TWP MI
48183-1473
US

IV. Provider business mailing address

1 FORD PL STE 2E
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-281-4197
  • Fax: 734-282-0093
Mailing address:
  • Phone: 313-874-4806
  • Fax: 348-761-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

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