Healthcare Provider Details

I. General information

NPI: 1144634403
Provider Name (Legal Business Name): HENRY FORD WYANDOTTE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 FORT STREET SUITE D ATTN DENISE
TRENTON MI
48183
US

IV. Provider business mailing address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

V. Phone/Fax

Practice location:
  • Phone: 734-391-3057
  • Fax: 734-391-3052
Mailing address:
  • Phone: 734-246-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MARK SMITH
Title or Position: SVP
Credential: MD
Phone: 517-205-6407