Provider Demographics
NPI:1730380254
Name:ASCENSION MEDICAL GROUP MICHIGAN
Entity type:Organization
Organization Name:ASCENSION MEDICAL GROUP MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-221-1918
Mailing Address - Street 1:PO BOX 14129
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37771 SCHOENHERR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2302
Practice Address - Country:US
Practice Address - Phone:586-274-2400
Practice Address - Fax:586-258-3333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION MEDICAL GROUP MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E020100OtherBCBSM GROUP NUMBER
MICB2735OtherRAILROAD MEDICARE GROUP NUMBER
MIDG7739OtherRAILROAD MEDICARE GROUP NUMBER
MI700E020100OtherBCBSM GROUP NUMBER
MIDG7739OtherRAILROAD MEDICARE GROUP NUMBER
MI4995487Medicaid
MI0P44640Medicare PIN
MIF88099Medicare UPIN
MI4994748Medicaid
MIP44640001Medicare PIN