# HENRY FORD SEMI MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HENRY FORD SEMI MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366515496
- **Authorized official:** KIMBERLY CEBALT (DIRECTOR OF PROVIDER AFFAIRS)
- **Authorized official phone:** (313) 874-6764

## Contact information

- **Practice address:** 21000 E 12 MILE RD, SUITE 102, SAINT CLAIR SHORES, MI 48081-1116
- **Practice address phone:** (586) 447-5100
- **Practice address fax:** (586) 447-5090
- **Mailing address:** PO BOX 670884, DETROIT, MI 48267-0884
- **Mailing address phone:** (800) 999-5829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VG0400X | Gynecology Physician | — | NULL | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 207VX0000X | Obstetrics Physician | — | NULL | — |
| 207VX0000X | Obstetrics Physician | — | — | — |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 04/28/2026