Healthcare Provider Details

I. General information

NPI: 1023114634
Provider Name (Legal Business Name): HENRY FORD MACOMB HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

215 NORTH AVE
MOUNT CLEMENS MI
48043-1716
US

V. Phone/Fax

Practice location:
  • Phone: 568-263-2705
  • Fax: 568-263-2255
Mailing address:
  • Phone: 568-263-2705
  • Fax: 568-263-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROBIN DAMSCHRODER
Title or Position: EXECUTIVE VICE PRESIDENT, FINANCE
Credential:
Phone: 313-876-8421