Healthcare Provider Details

I. General information

NPI: 1609747542
Provider Name (Legal Business Name): HENRY FORD HEALTH GENESYS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HEALTH PARK BLVD STE B
GRAND BLANC MI
48439-2558
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-1601
  • Fax: 810-249-4316
Mailing address:
  • Phone: 800-999-5829
  • Fax: 248-641-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CEBALT
Title or Position: MANAGER OF PROVIDER AFFAIRS
Credential:
Phone: 313-874-6764