Healthcare Provider Details

I. General information

NPI: 1114133485
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY
NOVI MI
48374-1213
US

IV. Provider business mailing address

PO BOX 14129
BELFAST ME
04915-4032
US

V. Phone/Fax

Practice location:
  • Phone: 248-680-8000
  • Fax: 248-292-3852
Mailing address:
  • Phone: 248-680-8000
  • Fax: 248-292-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: RACHEL R PERRY
Title or Position: MANAGER
Credential:
Phone: 248-221-1918