Organization
HENRY FORD MACOMB HOSPITAL CORPORATION
Active
Other names
Henry Ford Macomb Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY A GOODBALIAN (VP CMO)
(586) 263-2305
Entity
Organization
Contact information
Practice address
43411 GARFIELD RD, CLINTON TOWNSHIP, MI 48038-1152
(586) 226-7007
Mailing address
215 NORTH AVE, MOUNT CLEMENS, MI 48043-1716
(586) 226-7007
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
MI
103TC2200X
Clinical Child & Adolescent Psychologist
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680E062890
BLUE CROSS GROUP NUMBER
MI
Enumeration date
02/15/2007
Last updated
04/23/2021
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