Healthcare Provider Details

I. General information

NPI: 1538253935
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: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24555 HAIG ST
TAYLOR MI
48180-3322
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 313-292-6260
  • Fax: 313-375-2015
Mailing address:
  • Phone: 313-292-6260
  • Fax: 313-375-2015

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 Number5301004670
License Number StateMI

VIII. Authorized Official

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