Healthcare Provider Details

I. General information

NPI: 1679548952
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 KERCHEVAL AVE STE A
GROSSE POINTE FARMS MI
48236-3610
US

IV. Provider business mailing address

21651 MELROSE AVE
SOUTHFIELD MI
48075-7906
US

V. Phone/Fax

Practice location:
  • Phone: 313-640-2458
  • Fax: 313-640-2456
Mailing address:
  • Phone: 248-353-2468
  • Fax: 248-353-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JOHN POLANSKI
Title or Position: CEO COMMUNITY CARE SERVICES
Credential:
Phone: 248-723-0211