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General NPI Number Information
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NPI Number | 1396913893
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Entity Type | Organization
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Legal Business Name | ASCENSION MEDICAL GROUP MICHIGAN
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 36975 UTICA RD SUITE 102
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1685
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Country | US
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Telephone | 586-228-0500
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Fax | 586-228-3865
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Provider Business Mailing Address
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Address Line | PO BOX 14129
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City | BELFAST
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State | ME
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Zip | 04915-4032
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301059589
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License Number State | MI
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