Organization
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Active
Organization
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Active
Other names
PH Cardiology II/Providence Hosptial 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) 849-3306
(248) 849-8504
Mailing address
PO BOX 670884, DETROIT, MI 48267-0884
(800) 999-5829
(248) 641-4840
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060360240
BCBSM PIN NUMBR
MI
Enumeration date
04/20/2006
Last updated
07/16/2026
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