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NPI Code Detail

MEDICARE: HENRY FORD HEALTH ST. JOHN HOSPITAL

MEDICARE: HENRY FORD HEALTH ST. JOHN HOSPITAL
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
1261QA1903XAmbulatory Surgical Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
140073OTHERBLUE CROSS

General Provider Information

NPI Number : 1801198387
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENRY FORD HEALTH ST. JOHN HOSPITAL
Provider Business Mailing Address
First Line : 28000 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48092-2468
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17700 23 MILE RD
Second Line : STE 200
City : MACOMB
State : MI
Zip : 48044-1154
Country : US
Telephone Number : 586-753-0011
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : KIMBERLY CEBALT
Credential :
Telephone Number : 313-874-6764
Provider Enumeration Date : 12/03/2010
Last Update Date : 04/14/2026

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Directions to “HENRY FORD HEALTH ST. JOHN HOSPITAL ” Practice Location

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