Healthcare Provider Details

I. General information

NPI: 1144436411
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42645 GARFIELD RD
CLINTON TOWNSHIP MI
48038-5022
US

IV. Provider business mailing address

PO BOX 14129
BELFAST ME
04915-4032
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-4652
  • Fax:
Mailing address:
  • Phone: 248-680-8000
  • Fax: 248-292-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateMI

VIII. Authorized Official

Name: RACHEL R PERRY
Title or Position: MANAGER
Credential:
Phone: 248-221-1918