Healthcare Provider Details

I. General information

NPI: 1104994847
Provider Name (Legal Business Name): MITCHELL T PACE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 313-916-7425
  • Fax:
Mailing address:
  • Phone: 313-916-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number5101010036
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101010036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: