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General NPI Number Information
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NPI Number | 1376563767
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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 | 07/20/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 14555 LEVAN RD
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City | LIVONIA
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State | MI
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Zip | 48154-5083
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Country | US
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Telephone | 734-591-6409
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Fax | 734-591-6225
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Provider Business Mailing Address
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Address Line | 30100 TELEGRAPH RD SUITE 200
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4514
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Country | US
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Telephone | 248-723-0224
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Fax | 248-642-7852
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DAVID F SHEPHERD
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Credential |
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Telephone | 248-642-5038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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