Provider Demographics
NPI:1285950295
Name:HENRY FORD MACOMB HOSPITAL-WARREN CAMPUS
Entity type:Organization
Organization Name:HENRY FORD MACOMB HOSPITAL-WARREN CAMPUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL EDUCATION ADMIN. ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-759-7641
Mailing Address - Street 1:123 DOLPHIN AVE
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-3201
Mailing Address - Country:US
Mailing Address - Phone:248-921-2195
Mailing Address - Fax:
Practice Address - Street 1:123 DOLPHIN AVE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-3201
Practice Address - Country:US
Practice Address - Phone:248-921-2195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty