Provider Demographics
NPI:1356908594
Name:HENRY FORD WYANDOTTE
Entity type:Organization
Organization Name:HENRY FORD WYANDOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REGIONAL ONCOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:FRANGESCO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-287-1087
Mailing Address - Street 1:1640 FORT STREET
Mailing Address - Street 2:SUITE D : ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
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:734-246-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty