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Organization
HENRY FORD HEALTH ST. JOHN HOSPITAL
Active
Organization
HENRY FORD HEALTH ST. JOHN HOSPITAL
Active
Other names
St John Hospital Nurse Practitioner
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CEBALT (MANAGER PROVIDER AFFAIRS)
(313) 874-6764
Entity
Organization
Contact information
Practice address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(248) 680-8000
Mailing address
PO BOX 670884, DETROIT, MI 48267-0884
(800) 999-5829
(248) 641-4840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
MI
363LA2200X
Adult Health Nurse Practitioner
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OH 21741
NP BCBSM GROUP NUMBER
MI
Enumeration date
05/23/2006
Last updated
07/16/2026
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