Healthcare Provider Details

I. General information

NPI: 1598802936
Provider Name (Legal Business Name): HENRY FORD MACOMB HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

43421 GARFIELD RD STE 203
CLINTON TOWNSHIP MI
48038-1133
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2230
  • Fax: 586-263-2239
Mailing address:
  • Phone: 586-263-2622
  • Fax: 586-263-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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