Healthcare Provider Details

I. General information

NPI: 1134462559
Provider Name (Legal Business Name): MICHAEL ASHBROOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 FORT ST STE 110
TRENTON MI
48183-4698
US

IV. Provider business mailing address

3601 W 13 MILE RD DIVISION OF CARDIOVASCULAR MEDICINE
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-4176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301109754
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301109754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: