Basic Information
| Provider Information | |||||||||
| NPI: | 1881809226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENRY FORD HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 W GRAND BLVD STE 800 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139163121 | ||||||||
| FaxNumber: | 3139161630 | ||||||||
| Practice Location | |||||||||
| Address1: | 3031 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139163121 | ||||||||
| FaxNumber: | 3139161630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ACHARYA | ||||||||
| AuthorizedOfficialFirstName: | NEELIMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR STAFF PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3139163121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 4301059649 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.