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General NPI Number Information
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NPI Number | 1104040609
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Entity Type | Organization
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Legal Business Name | HENRY FORD HOSPITAL
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-8144
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Fax | 313-916-4460
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Provider Business Mailing Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-8144
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Fax | 313-916-4460
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Authorized Official
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Title or Position | MANAGER
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Name | JODIE ROBERTS
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Credential |
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Telephone | 248-641-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 4301072583
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License Number State | MI
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