Healthcare Provider Details

I. General information

NPI: 1457586646
Provider Name (Legal Business Name): HENRY FORD WYANDOTTE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192
US

IV. Provider business mailing address

2333 BIDDLE AVE
WYANDOTTE MI
48192
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-3516
  • Fax:
Mailing address:
  • Phone: 734-324-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

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