Healthcare Provider Details

I. General information

NPI: 1639344930
Provider Name (Legal Business Name): ASCENSION MACOMB OAKLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E JEFFERSON AVE STE 70
DETROIT MI
48214-3730
US

IV. Provider business mailing address

2800 LIVERNOIS RD STE 500
TROY MI
48083-1219
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax: 313-499-4953
Mailing address:
  • Phone: 248-680-8121
  • Fax: 248-636-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateMI

VIII. Authorized Official

Name: SARAH STARKEL
Title or Position: SUPERVISOR
Credential:
Phone: 248-680-8121