| Henry Ford Health System | |
|
2799 W Grand Blvd Detroit MI 48202-2608 | |
| (313) 916-2600 | |
| Not Available |
| Full Name | Henry Ford Health System |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 2799 W Grand Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Kelly Ratowski (DIRECTOR) |
| Authorized Official Contact | 2487032003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Henry Ford Health System 2799 W Grand Blvd Detroit MI 48202-2608 Ph: (313) 916-2600 | Henry Ford Health System 2799 W Grand Blvd Detroit MI 48202-2608 Ph: (313) 916-2600 |
| NPI Number | 1801970124 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 03/06/2024 |
| Medicare PECOS PAC ID | 0547178311 |
|---|---|
| Medicare Enrollment ID | O20041129000860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801970124 | NPI | - | NPPES |
| Provider Name | Ghabi A Kaspo |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1912923855 PECOS PAC ID: 4981610425 Enrollment ID: I20060223000295 |
| Provider Name | Benjamin T Barbetta |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1982902821 PECOS PAC ID: 3779880521 Enrollment ID: I20170823002936 |
| Provider Name | Tanaya Porter |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1679829659 PECOS PAC ID: 9931401536 Enrollment ID: I20220317000902 |
| Provider Name | Jerrold Armstrong |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467175521 PECOS PAC ID: 7012384480 Enrollment ID: I20221028000513 |
| Provider Name | Angela Melody-oska Douglas |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1043696552 PECOS PAC ID: 7618261124 Enrollment ID: I20230817000723 |
| Provider Name | Rushil Rajiv Dang |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1346613312 PECOS PAC ID: 5991084584 Enrollment ID: I20231208002930 |
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