Healthcare Provider Details

I. General information

NPI: 1104040609
Provider Name (Legal Business Name): HENRY FORD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8144
  • Fax: 313-916-4460
Mailing address:
  • Phone: 313-916-8144
  • Fax: 313-916-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number4301072583
License Number StateMI

VIII. Authorized Official

Name: JODIE ROBERTS
Title or Position: MANAGER
Credential:
Phone: 248-641-4041