# HENRY FORD HEALTH ST. JOHN HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St John Hospital Nurse Practitioner
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700831500
- **Authorized official:** KIMBERLY CEBALT (MANAGER PROVIDER AFFAIRS)
- **Authorized official phone:** (313) 874-6764

## Contact information

- **Practice address:** 1 FORD PL STE 3A, DETROIT, MI 48202-3450
- **Practice address phone:** (248) 680-8000
- **Mailing address:** PO BOX 670884, DETROIT, MI 48267-0884
- **Mailing address phone:** (800) 999-5829
- **Mailing address fax:** (248) 641-4840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | — | MI | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | MI | — |

## Other

- **Enumeration date:** 05/23/2006
- **Last updated:** 07/16/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | OH 21741 | NP BCBSM GROUP NUMBER | MI |