Provider Demographics
NPI:1912917931
Name:HENRY FORD MEDICAL CENTER LAKESIDE
Entity Type:Organization
Organization Name:HENRY FORD MEDICAL CENTER LAKESIDE
Other - Org Name:HENRY FORD HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, CHIEF FIN & BUS DEV OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMSCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-648-7204
Mailing Address - Street 1:14500 HALL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14500 HALL RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1229
Practice Address - Country:US
Practice Address - Phone:586-247-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI41033OtherBLUE CROSS BLUE SHIELD OF