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General NPI Number Information
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NPI Number | 1376820605
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Entity Type | Organization
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Legal Business Name | ASCENSION ST. JOHN HOSPITAL
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 21000 E 12 MILE RD STE 111
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1156
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Country | US
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Telephone | 586-779-7610
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Fax | 586-779-0031
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Provider Business Mailing Address
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Address Line | 3187 SOLUTIONS CTR
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City | CHICAGO
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State | IL
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Zip | 60677-3001
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Country | US
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Telephone | 248-680-8000
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Fax | 248-292-3852
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Authorized Official
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Title or Position | MANAGER
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Name | RACHEL R PERRY
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Credential |
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Telephone | 248-221-1918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | MI
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