Healthcare Provider Details

I. General information

NPI: 1962570408
Provider Name (Legal Business Name): MARYANN CASTRO YAMAMOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 6100 HAGGERTY ROAD
CANTON MI
48187
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 6100 HAGGERTY ROAD
CANTON MI
48187
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-3200
  • Fax: 734-981-4354
Mailing address:
  • Phone: 734-981-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301066441
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301066441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: