Basic Information
| Provider Information | |||||||||
| NPI: | 1801992557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION MEDICAL GROUP MICHIGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28000 DEQUINDRE | ||||||||
| Address2: | REVENUE CYCLE DEPARTMENT | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480921135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486808000 | ||||||||
| FaxNumber: | 2482923852 | ||||||||
| Practice Location | |||||||||
| Address1: | 13935 PLUMBROOK RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483121727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869399900 | ||||||||
| FaxNumber: | 5869398246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | STARKEL | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 2486808121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 5901002120 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0000X | 5901002120 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0103X | 5901002120 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 5901002120 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213EP1101X | 5901002120 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0E02063 | 01 | MI | BCBSM DME NUMBER | OTHER | 700E012740 | 01 | MI | BCBSM GROUP NUMBER | OTHER | CB2735 | 01 | MI | RAILROAD MEDICARE GROUP NUMBER | OTHER | CA6965 | 01 | MI | RAILROAD MEDICARE GROUP NUMBER | OTHER | 5501280 | 01 | MI | BCBS PIN | OTHER | 540E020630 | 01 | MI | BCBS DME SUPPLIER NUMBER | OTHER |