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General NPI Number Information
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NPI Number | 1538179551
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Entity Type | Organization
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Legal Business Name | HENRY FORD MEDICAL CENTER FAIRLANE
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 19401 HUBBARD DR
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City | DEARBORN
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State | MI
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Zip | 48126-2641
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Country | US
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Telephone | 313-982-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 19401 HUBBARD DR
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City | DEARBORN
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State | MI
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Zip | 48126-2641
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EVP, CHIEF FIN & BUS DEV OFFICE
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Name | ROBIN DAMSCHRODER
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Credential |
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Telephone | 248-648-7204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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