Healthcare Provider Details

I. General information

NPI: 1104989730
Provider Name (Legal Business Name): ATSUSHI YOSHIDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 2799 WEST GRAND BOULEVARD
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 2799 WEST GRAND BOULEVARD
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-7178
  • Fax: 313-916-4353
Mailing address:
  • Phone: 313-916-7178
  • Fax: 313-916-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number4301076128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: