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NPI Code Detail

MEDICARE: ASCENSION MEDICAL GROUP MICHIGAN

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
1207Q00000XFamily Medicine Physician4301059589MI

General Provider Information

NPI Number : 1396913893
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 : 36975 UTICA RD
Second Line : SUITE 102
City : CLINTON TOWNSHIP
State : MI
Zip : 48036-1685
Country : US
Telephone Number : 586-228-0500
Fax Number : 586-228-3865
Authorized Official
Title or Position : MANAGER
Name : RACHEL R PERRY
Credential :
Telephone Number : 248-221-1918
Provider Enumeration Date : 02/19/2008
Last Update Date : 04/16/2025

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Directions to “ASCENSION MEDICAL GROUP MICHIGAN ” Practice Location

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