Organization
HENRY FORD HEALTH SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES CONNELLY (SR VP CFO)
(313) 876-8714
Entity
Organization
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
830190
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680H21247
CLINICAL PSYCHOLOGIST
MI
Enumeration date
11/09/2006
Last updated
08/22/2020
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