Healthcare Provider Details

I. General information

NPI: 1548759830
Provider Name (Legal Business Name): HEGE FINVOLD HEGGUM M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date: 12/13/2018
Reactivation Date: 01/22/2019

III. Provider practice location address

HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT 2799 W. GRAND BOULEVARD
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT 2799 W. GRAND BOULEVARD
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-874-5378
  • Fax:
Mailing address:
  • Phone: 313-874-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: