Healthcare Provider Details

I. General information

NPI: 1578735015
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD STE 100B
DETROIT MI
48202-2608
US

IV. Provider business mailing address

30100 TELEGRAPH RD STE 200
BINGHAM FARMS MI
48025-4514
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-1666
  • Fax: 313-916-1237
Mailing address:
  • Phone: 248-642-1111
  • Fax: 248-642-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008797
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL KUS
Title or Position: VP AMBULATORY PHCY
Credential: RPH
Phone: 248-642-1111