Healthcare Provider Details

I. General information

NPI: 1124421888
Provider Name (Legal Business Name): HENRY FORD MACOMB HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

V. Phone/Fax

Practice location:
  • Phone: 800-532-2411
  • Fax:
Mailing address:
  • Phone: 800-532-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNON PHILLIPS
Title or Position: ENROLLMENT
Credential:
Phone: 313-874-2892