Organization
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Active
Other names
HENRY FORD PROVIDENCE HOSPITAL, PH General Surgery/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
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(248) 680-8000
(248) 292-3852
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020F364690
MI BLUE CROSS GROUP PIN#
MI
Enumeration date
04/19/2006
Last updated
04/10/2026
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