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NPI Code Detail

MEDICARE: ASCENSION ST JOHN HOSPITAL

MEDICARE: ASCENSION ST JOHN HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist
2213E00000XPodiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10E0110OTHERBLUE CROSS

General Provider Information

NPI Number : 1043478910
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASCENSION ST JOHN HOSPITAL
Provider Business Mailing Address
First Line : 28000 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48092-2468
Country : US
Telephone Number : 586-753-0275
Fax Number :
Provider Business Practice Location Address
First Line : 26755 BALLARD ST
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-2419
Country : US
Telephone Number : 584-655-5501
Fax Number :
Authorized Official
Title or Position : VP FINANCE
Name : CHRISTOPHER J PALAZZOLO
Credential :
Telephone Number : 313-343-3558
Provider Enumeration Date : 05/28/2008
Last Update Date : 12/12/2018

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Directions to “ASCENSION ST JOHN HOSPITAL ” Practice Location

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