Healthcare Provider Details

I. General information

NPI: 1720233968
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17900 23 MILE RD SUITE 406
MACOMB MI
48044-1161
US

IV. Provider business mailing address

PO BOX 14129
BELFAST ME
04915-4032
US

V. Phone/Fax

Practice location:
  • Phone: 586-868-9075
  • Fax: 586-868-9077
Mailing address:
  • Phone: 248-680-8000
  • Fax: 248-292-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: SARAH STARKEL
Title or Position: SUPERVISOR
Credential:
Phone: 248-680-8000