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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301005814	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2042145	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548271059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FORD MACOMB HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	16151 19 MILE RD
Second Line	:	STE 100
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1158
Country	:	US
Telephone Number	:	586-263-2677
Fax Number	:	586-263-2567

Provider Business Practice Location Address
First Line	:	16151 19 MILE RD
Second Line	:	STE 100
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1158
Country	:	US
Telephone Number	:	586-263-2677
Fax Number	:	586-263-2567

Authorized Official
Title or Position	:	VP OF PHARMACY
Name	:	DAN KUS
Credential	:	RPH
Telephone Number	:	248-723-0255

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/19/2017

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