MEDICARE: ASCENSION MEDICAL GROUP MICHIGAN

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	207VX0000X	Obstetrics Physician
2	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1326257148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION MEDICAL GROUP MICHIGAN

Provider Business Mailing Address
First Line	:	PO BOX 14129
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4032
Country	:	US
Telephone Number	:	248-680-8000
Fax Number	:	248-292-3852

Provider Business Practice Location Address
First Line	:	15990 W 9 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-4826
Country	:	US
Telephone Number	:	248-849-4229
Fax Number	:	248-849-4240

Authorized Official
Title or Position	:	MANAGER
Name	:	RACHEL R PERRY
Credential	:
Telephone Number	:	248-221-1918

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	04/16/2025

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