Healthcare Provider Details

I. General information

NPI: 1043478910
Provider Name (Legal Business Name): ASCENSION ST JOHN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26755 BALLARD ST
HARRISON TOWNSHIP MI
48045-2419
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 584-655-5501
  • Fax:
Mailing address:
  • Phone: 586-753-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J PALAZZOLO
Title or Position: VP FINANCE
Credential:
Phone: 313-343-3558