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	261QU0200X	Urgent Care Clinic/Center		MI

General Provider Information

NPI Number	:	1205060076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD MACOMB HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	80650 VAN DYKE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-1333
Country	:	US
Telephone Number	:	810-798-6433
Fax Number	:	810-798-6436

Provider Business Practice Location Address
First Line	:	80650 VAN DYKE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-1333
Country	:	US
Telephone Number	:	810-798-6433
Fax Number	:	810-798-6436

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER AFFAIRS
Name	:	MR. KELLY RATOWSKI
Credential	:
Telephone Number	:	248-703-2003

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	03/06/2024

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