Basic Information
| Provider Information | |||||||||
| NPI: | 1538426655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENRY FORD HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2799 WEST GRAND BLVD | ||||||||
| Address2: | HENRY FORD HOSPITAL | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481012608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139162600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2799 WEST GRAND BLVD | ||||||||
| Address2: | HENRY FORD HOSPITAL | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481012608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139162600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 04/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | ARIAS-STELLA | ||||||||
| AuthorizedOfficialFirstName: | JAVIER | ||||||||
| AuthorizedOfficialMiddleName: | AUGUSTO | ||||||||
| AuthorizedOfficialTitleorPosition: | PGY1 | ||||||||
| AuthorizedOfficialTelephone: | 3139162600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | Y | Hospitals | Long Term Care Hospital |
No ID Information.