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Organization

HENRY FORD HEALTH ST. JOHN HOSPITAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY CEBALT (DIRECTOR PROVIDER AFFAIRS)
(313) 874-6764
Entity
Organization

Contact information

Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4000
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(248) 680-8000

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
207Q00000X
Family Medicine Physician
207QG0300X
Geriatric Medicine (Family Medicine) Physician
207R00000X
Internal Medicine Physician
Primary
207RC0000X
Cardiovascular Disease Physician
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
207RP1001X
Pulmonary Disease Physician
207V00000X
Obstetrics & Gynecology Physician
207VM0101X
Maternal & Fetal Medicine Physician
207Y00000X
Otolaryngology Physician
208000000X
Pediatrics Physician
2080P0202X
Pediatric Cardiology Physician
2084N0400X
Neurology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
Q262160
BLUE CROSS
Enumeration date
06/09/2008
Last updated
02/27/2026
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