Provider Demographics
NPI:1790069714
Name:HENRY FORD MACOMB HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:HENRY FORD MACOMB HOSPITAL CORPORATION
Other - Org Name:HENRY FORD MACOMB HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-703-2003
Mailing Address - Street 1:PO BOX 670844
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0844
Mailing Address - Country:US
Mailing Address - Phone:800-999-5829
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:15520 19 MILE RD
Practice Address - Street 2:SUITE 430
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6333
Practice Address - Country:US
Practice Address - Phone:586-228-6200
Practice Address - Fax:586-228-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207X00000X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty