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General NPI Number Information
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NPI Number | 1750407953
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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 | 03/21/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2825 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-1214
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Country | US
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Telephone | 248-689-8830
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Fax | 248-689-8272
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Provider Business Mailing Address
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Address Line | 448 FOX HILLS DR S APT. # 1
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City | BLOOMFIELD
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State | MI
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Zip | 48304-1352
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Country | US
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Telephone | 248-253-0185
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Fax | 248-689-8272
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Authorized Official
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Title or Position | PA-C NEUROSURGERY
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Name | MR. MOHAMMAD MUSTAQUIM
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Credential | PA-C
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Telephone | 248-689-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 5601003917
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License Number State | MI
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