# HENRY FORD HEALTH PROVIDENCE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PH Internal Medicine/Providence Hospital and Medical Centers Inc, HENRY FORD PROVIDENCE HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922063213
- **Authorized official:** KIMBERLY CEBALT (DIRECTOR)
- **Authorized official phone:** (313) 874-6764

## Contact information

- **Practice address:** 16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
- **Practice address phone:** (248) 849-3000
- **Practice address fax:** (248) 849-2244
- **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 |
| --- | --- | --- | --- | --- |
| 163WD0400X | Diabetes Educator Registered Nurse | — | NULL | — |
| 163WD0400X | Diabetes Educator Registered Nurse | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/19/2006
- **Last updated:** 07/16/2026