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NPI Code Detail

MEDICARE: HENRY FORD HEALTH SYSTEM

MEDICARE: HENRY FORD HEALTH SYSTEM
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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy5301005292MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22040715OTHERPK

General Provider Information

NPI Number : 1447344841
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENRY FORD HEALTH SYSTEM
Provider Business Mailing Address
First Line : 30100 TELEGRAPH RD
Second Line : STE 200
City : BINGHAM FARMS
State : MI
Zip : 48025-4514
Country : US
Telephone Number : 586-977-9971
Fax Number : 586-977-6230
Provider Business Practice Location Address
First Line : 3500 15 MILE RD
Second Line :
City : STERLING HTS
State : MI
Zip : 48310-5353
Country : US
Telephone Number : 586-977-9971
Fax Number : 586-977-6230
Authorized Official
Title or Position : VP, PHARMACY SERVICES
Name : DANIEL KUS
Credential : RPH
Telephone Number : 248-642-1111
Provider Enumeration Date : 10/03/2006
Last Update Date : 12/02/2016

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Practice Fax:
1144355934 — AMAL MOUSTAFA OMRAN MD
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1629291125 — MS. DOROTHY LEE PEYROLO CERT PHARMACY TECH
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1881819746 — MRS. SUSAN JEAN HERRMANN CPHT
Practice Location Address:
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