Healthcare Provider Details

I. General information

NPI: 1790069714
Provider Name (Legal Business Name): HENRY FORD MACOMB HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15520 19 MILE RD SUITE 430
CLINTON TOWNSHIP MI
48038-6333
US

IV. Provider business mailing address

PO BOX 670844
DETROIT MI
48267-0844
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-6200
  • Fax: 586-228-6201
Mailing address:
  • Phone: 800-999-5829
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KELLY RATOWSKI
Title or Position: DIRECTOR OF PROVIDER AFFAIRS
Credential:
Phone: 248-703-2003