Healthcare Provider Details

I. General information

NPI: 1447363270
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 BECK ROAD
PLYMOUTH MI
48170
US

IV. Provider business mailing address

16692 RENWICK STREET
LIVONIA MI
48154
US

V. Phone/Fax

Practice location:
  • Phone: 734-354-5950
  • Fax:
Mailing address:
  • Phone: 734-464-9257
  • Fax: 734-354-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5302029042
License Number StateMI

VIII. Authorized Official

Name: MRS. KAREN PURCELL-KOBEL
Title or Position: REGISTERED PHARMACIST
Credential: RPH
Phone: 734-464-9257