Provider Demographics
NPI:1750407953
Name:HENRY FORD HOSPITAL
Entity type:Organization
Organization Name:HENRY FORD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C NEUROSURGERY
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAQUIM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:248-689-8830
Mailing Address - Street 1:448 FOX HILLS DR S
Mailing Address - Street 2:APT. # 1
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1352
Mailing Address - Country:US
Mailing Address - Phone:248-253-0185
Mailing Address - Fax:248-689-8272
Practice Address - Street 1:2825 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1214
Practice Address - Country:US
Practice Address - Phone:248-689-8830
Practice Address - Fax:248-689-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003917282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access