Healthcare Provider Details

I. General information

NPI: 1083708481
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KERCHEVAL AVE SUITE 110
GROSSE POINTE FARMS MI
48236-3629
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 313-640-2591
  • Fax: 313-640-2571
Mailing address:
  • Phone: 313-640-2591
  • Fax: 313-640-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007268
License Number StateMI

VIII. Authorized Official

Name: DANIEL KUS
Title or Position: VP, PHARMACY SERVICES
Credential: RPH
Phone: 248-642-1111