Provider Demographics
NPI:1801992557
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:248-680-8000
Mailing Address - Fax:248-292-3852
Practice Address - Street 1:13935 PLUMBROOK RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1727
Practice Address - Country:US
Practice Address - Phone:586-939-9900
Practice Address - Fax:586-939-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002120213E00000X, 213ES0000X, 213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E02063OtherBCBSM DME NUMBER
MI540E020630OtherBCBS DME SUPPLIER NUMBER
MI700E012740OtherBCBSM GROUP NUMBER
MICA6965OtherRAILROAD MEDICARE GROUP NUMBER
MI5501280OtherBCBS PIN
MICB2735OtherRAILROAD MEDICARE GROUP NUMBER
MI0N40170Medicare PIN
MI0E02063OtherBCBSM DME NUMBER