Provider Demographics
NPI:1235306366
Name:HENRY FORD WYANDOTTE HOSPITAL
Entity Type:Organization
Organization Name:HENRY FORD WYANDOTTE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGERY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:573-268-6443
Mailing Address - Street 1:2333 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4668
Mailing Address - Country:US
Mailing Address - Phone:734-287-9029
Mailing Address - Fax:734-287-9129
Practice Address - Street 1:2333 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-287-9029
Practice Address - Fax:734-287-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital