Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Henry Ford Health St John Hospital

Organization Allergy & Immunology (Internal Medicine) Physician · NPI 1376820605

Henry Ford Health St John Hospital is an Allergy & Immunology (Internal Medicine) Physician in Saint Clair Shores, Michigan. Licensed in Michigan. Registered with an NPI since 2011.

Licensed in
MI
In the registry since
2011
Specialties on file
7

Practice location Address checks out

21000 E 12 Mile Rd Ste 111
Saint Clair Shores, MI 48081-1156
Phone: (586) 779-7610
Fax: (586) 779-0031
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X (MI)
Allergy & Immunology (Internal Medicine) Physician Taxonomy 207RA0201X (MI)
Pediatric Otolaryngology Physician Taxonomy 207YP0228X (MI)
Facial Plastic Surgery Physician Taxonomy 207YS0123X (MI)
Plastic Surgery within the Head & Neck (Otolaryngology) Physician Taxonomy 207YX0007X (MI)
Otology & Neurotology Physician Taxonomy 207YX0901X (MI)
Otolaryngology/Facial Plastic Surgery Physician Taxonomy 207YX0905X (MI)

Record details

NPI number1376820605
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kimberly Cebalt — Director · (313) 874-6764
Other names Henry Ford St. John Hospital; Lakeshore Ent Center; Lakeshore Ent Center
NPI enumeratedNovember 15, 2011
Last updated in NPPESMay 19, 2026
Certification dateMay 19, 2026
Mailing addressPo Box 670884, Detroit, MI 48267-0884