Healthcare Provider Details

I. General information

NPI: 1477016772
Provider Name (Legal Business Name): ASHLEY MARIE DECALUWE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 12/30/2024
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45441 HEYDENREICH RD
MACOMB MI
48044-6601
US

IV. Provider business mailing address

45441 HEYDENREICH RD
MACOMB MI
48044-6601
US

V. Phone/Fax

Practice location:
  • Phone: 586-226-8600
  • Fax: 586-226-8686
Mailing address:
  • Phone: 586-226-8600
  • Fax: 586-226-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101027047
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: