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General NPI Number Information
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NPI Number | 1114001468
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Entity Type | Organization
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Legal Business Name | HENRY FORD HEALTH SYSTEM
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/06/2024
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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 | 313-916-2600
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Fax |
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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 | 313-916-2600
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OFFICE OF PROVIDER AFFAIRS
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Name | MR. KELLY RATOWSKI
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Credential |
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Telephone | 248-703-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 830190
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License Number State | MI
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