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General NPI Number Information
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NPI Number | 1225093776
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Entity Type | Organization
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Legal Business Name | ASCENSION PROVIDENCE HOSPITAL
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-849-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3168 SOLUTIONS CENTER BOX 773168
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 248-680-8000
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | SARAH STARKEL
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Credential |
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Telephone | 248-680-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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