Healthcare Provider Details

I. General information

NPI: 1770984601
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19229 MACK AVE SUITE 27
GROSSE POINTE WOODS MI
48236-2858
US

IV. Provider business mailing address

PO BOX 14129
BELFAST ME
04915-4032
US

V. Phone/Fax

Practice location:
  • Phone: 313-647-3292
  • Fax: 313-884-6054
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateMI

VIII. Authorized Official

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