Provider Demographics
NPI:1710257639
Name:HENRY FORD HOSPITAL
Entity Type:Organization
Organization Name:HENRY FORD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-693-0415
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-2600
Mailing Address - Fax:
Practice Address - Street 1:4461 PARNELL ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4052
Practice Address - Country:US
Practice Address - Phone:248-343-9892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704188736282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital