Healthcare Provider Details

I. General information

NPI: 1114962461
Provider Name (Legal Business Name): ASCENSION MACOMB OAKLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

3195 SOLUTIONS CENTER BOX 773195
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 248-680-8000
  • Fax:
Mailing address:
  • Phone: 248-680-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateFM

VIII. Authorized Official

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