Healthcare Provider Details

I. General information

NPI: 1982170312
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP GENESYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 S BELSAY RD STE C
BURTON MI
48509-1948
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-743-3351
  • Fax: 810-244-1239
Mailing address:
  • Phone: 810-424-2136
  • Fax: 810-249-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM EDGAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 810-424-2025