MEDICARE: HENRY FORD MACOMB HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023114634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD MACOMB HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	215 NORTH AVE
Second Line	:
City	:	MOUNT CLEMENS
State	:	MI
Zip	:	48043-1716
Country	:	US
Telephone Number	:	568-263-2705
Fax Number	:	568-263-2255

Provider Business Practice Location Address
First Line	:	15855 19 MILE RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-3504
Country	:	US
Telephone Number	:	568-263-2705
Fax Number	:	568-263-2255

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT, FINANCE
Name	:	ROBIN DAMSCHRODER
Credential	:
Telephone Number	:	313-876-8421

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	12/17/2025

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Directions to “HENRY FORD MACOMB HOSPITAL CORPORATION ” Practice Location

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