Healthcare Provider Details

I. General information

NPI: 1356908594
Provider Name (Legal Business Name): HENRY FORD WYANDOTTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

1640 FORT STREET SUITE D : ATTN DENISE
TRENTON MI
48183
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: FRANGESCO TORTI
Title or Position: DIRECTOR REGIONAL ONCOLOGY
Credential:
Phone: 734-287-1087