Healthcare Provider Details

I. General information

NPI: 1164692158
Provider Name (Legal Business Name): HENRY FORD MACOMB HOSPITAL WARREN CAMPUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD
WARREN MI
48089-2048
US

IV. Provider business mailing address

13355 E 10 MILE RD
WARREN MI
48089-2048
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7691
  • Fax: 586-756-2242
Mailing address:
  • Phone: 586-759-7691
  • Fax: 586-756-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5101017399
License Number StateMI

VIII. Authorized Official

Name: MS. OLGA KIOUSIS
Title or Position: RESIDENCY COORDINATOR MED ED.
Credential:
Phone: 586-759-7691