Organization
HENRY FORD HEALTH ST. JOHN HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CEBALT (MANAGER)
(313) 874-6764
Entity
Organization
Contact information
Practice address
21000 E 12 MILE RD, SAINT CLAIR SHORES, MI 48081-1116
(586) 753-0011
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0011
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40116
BCBSM PIN
MI
Enumeration date
03/07/2007
Last updated
04/14/2026
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