Organization · Type 2 NPI

W.a. Foote Memorial Hospital

Plastic and Reconstructive Surgery Physician · Jackson, MI

NPI number 1780121970 Active

Practice location

205 N. East Ave
Jackson, MI 49201

Call (517) 841-7843 Map

Fax (517) 841-7419

Mailing address

PO Box 670884
Detroit, MI 48267-0884

Specialties and licenses

Taxonomy	Code	License
Plastic and Reconstructive Surgery Physician Primary	2086S0122X	1060000044 (MI)

Plastic and Reconstructive Surgery Physician: A surgeon who specializes in plastic and reconstructive surgery.

42 other providers at this address

NPI record

NPI: 1780121970
Entity type: Organization (Type 2)
Issued: Jan 25, 2017
Last updated: Oct 22, 2026
Status: Active

Other names

<unavail>
Henry Ford Allegiance Health · doing business as
Henry Ford Allegiance Health · doing business as
Henry Ford Jackson Health · doing business as

Authorized official

Kimberly Cebalt
Director
(313) 874-6764

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1780121970

W.a. Foote Memorial Hospital's National Provider Identifier is 1780121970, issued on Jan 25, 2017. The primary taxonomy on file is Plastic and Reconstructive Surgery Physician (2086S0122X), and the practice location is in Jackson, MI. The record was last updated on Oct 22, 2026.