1396913893 NPI number — ASCENSION MEDICAL GROUP MICHIGAN

Table of content: (NPI 1396913893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396913893 NPI number — ASCENSION MEDICAL GROUP MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION MEDICAL GROUP MICHIGAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396913893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-680-8000
Provider Business Mailing Address Fax Number:
248-292-3852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36975 UTICA RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-1685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-228-0500
Provider Business Practice Location Address Fax Number:
586-228-3865
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
248-221-1918

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301059589 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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