Healthcare Provider Details

I. General information

NPI: 1073799276
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 SOUTH BLVD E
ROCHESTER HILLS MI
48307-5453
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 800-456-2112
  • Fax: 888-400-0109
Mailing address:
  • Phone: 248-642-1111
  • Fax: 248-642-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301008716
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008716
License Number StateMI

VIII. Authorized Official

Name: DANIEL PAUL KUS
Title or Position: VP OF PHARMACY
Credential:
Phone: 248-723-0255