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1114962461

NPI Code Detail

MEDICARE: ASCENSION MACOMB OAKLAND HOSPITAL

MEDICARE: ASCENSION MACOMB OAKLAND 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
1	2086S0122X	Plastic and Reconstructive Surgery Physician		FM
2	208200000X	Plastic Surgery Physician
3	207T00000X	Neurological Surgery Physician
4	207W00000X	Ophthalmology Physician		MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG3113	OTHER	MI	RAILROAD MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180E01180	OTHER	MI	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1114962461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION MACOMB OAKLAND HOSPITAL

Provider Business Mailing Address
First Line	:	3195 SOLUTIONS CENTER BOX 773195
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0001
Country	:	US
Telephone Number	:	248-680-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	27351 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3487
Country	:	US
Telephone Number	:	248-680-8000
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	SARAH STARKEL
Credential	:
Telephone Number	:	248-680-8121

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/15/2023

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Directions to “ASCENSION MACOMB OAKLAND HOSPITAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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