Healthcare Provider Details

I. General information

NPI: 1922397058
Provider Name (Legal Business Name): ASCENSION ST JOHN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22301 FOSTER WINTER DR 2N FLOOR
SOUTHFIELD MI
48075-3707
US

IV. Provider business mailing address

22301 FOSTER WINTER DR 2ND FLOOR
SOUTHFIELD MI
48075-3707
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-0620
  • Fax: 248-557-3398
Mailing address:
  • Phone: 248-552-0620
  • Fax: 248-557-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateMI

VIII. Authorized Official

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