NPIMap

Organization Active NPI

Henry Ford Wyandotte Hospital

  • Physician Assistant
  • Wyandotte, MI
National Provider Identifier
1710315932
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
HENRY FORD WYANDOTTE HOSPITAL
Practice address
2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone
(734) 225-9112
Fax
(734) 225-9176
NPI assigned
Oct 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Smith, MD
Title
SVP
Phone
(517) 205-6407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

2333 Biddle Ave
Wyandotte, MI 48192-4668

Mailing address

1640 Fort Street
Suite D Attn Denis
Trenton, MI 48183
Phone (734) 391-3057

Other identifiers 1

IdentifierTypeStateIssuer
0H28864OtherMIBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040227000431 MI Part B Supplier - Clinic/Group Practice 2264334499 Receives reassigned benefits from 245 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rockwood, MI; Wyandotte, MI; Trenton, MI; Southgate, MI; Novi, MI; Brownstown TWP, MI; Allen Park, MI

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2070 Biddle Ave
Wyandotte, MI 48192
Phone (734) 225-9100

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1710315932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 FORT STREET",
            "address_2": "SUITE D ATTN DENIS",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "48183",
            "telephone_number": "734-391-3057",
            "fax_number": "734-391-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "734-225-9112",
            "fax_number": "734-225-9176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD WYANDOTTE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "517-205-6407",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0H28864",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.