Organization
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Active
Other names
PH Pulmonary Disease/Providence Hospital and Medical Centers Inc
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CEBALT (DIRECTOR)
(313) 874-6764
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
(248) 849-2244
Mailing address
3168 SOLUTIONS CENTER BOX 773168, CHICAGO, IL 60677-0001
(248) 680-8000
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290F372760
MI BLUE CROSS GROUP PIN #
MI
Enumeration date
04/20/2006
Last updated
04/12/2026
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