Organization
HENRY FORD SEMI MEDICAL GROUP
Active
Other names
HENRY FORD SEMI MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CEBALT (DIRECTOR OF PROVIDER AFFAIRS)
(313) 874-6764
Entity
Organization
Contact information
Practice address
11900 E 12 MILE RD STE 210, WARREN, MI 48093-3490
(586) 582-7100
(586) 582-7101
Mailing address
PO BOX 670884, DETROIT, MI 48267-0884
(800) 999-5829
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MI
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
MI
207R00000X
Internal Medicine Physician
—
MI
207RC0000X
Cardiovascular Disease Physician
—
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
MI
207V00000X
Obstetrics & Gynecology Physician
—
MI
207W00000X
Ophthalmology Physician
—
MI
208000000X
Pediatrics Physician
—
MI
2085R0202X
Diagnostic Radiology Physician
—
MI
2085U0001X
Diagnostic Ultrasound Physician
—
MI
208600000X
Surgery Physician
—
MI
208D00000X
General Practice Physician
—
MI
208M00000X
Hospitalist Physician
—
MI
363A00000X
Physician Assistant
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E012740
BCBSM GROUP #
MI
Enumeration date
07/28/2006
Last updated
04/28/2026
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