Provider Demographics
NPI:1043476955
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:HENRY FORD HEALTH PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP COMMUNITY CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-1111
Mailing Address - Street 1:21651 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7906
Mailing Address - Country:US
Mailing Address - Phone:248-353-2468
Mailing Address - Fax:248-353-4260
Practice Address - Street 1:16151 19 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1158
Practice Address - Country:US
Practice Address - Phone:586-203-1040
Practice Address - Fax:586-203-1041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY FORD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-30
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E03061OtherBCBS OF MICHIGAN
MI540E03061OtherBCBS OF MICHIGAN