Provider Demographics
NPI:1770793325
Name:HENRY FORD HEALTH SYSTEM
Entity type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMGOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SATYANARAYANA KONANUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-916-7545
Mailing Address - Street 1:1350 W BETHUNE ST
Mailing Address - Street 2:#1701
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2600
Mailing Address - Country:US
Mailing Address - Phone:734-353-9335
Mailing Address - Fax:
Practice Address - Street 1:VATTIKUTI UROLOGY INSTITUTE, K-9
Practice Address - Street 2:HENRY FORD HOSPITAL, 2799 W. BETHUNE AVENUE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43375261342088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty