# ASCENSION PROVIDENCE HOSPTIAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053684647
- **Authorized official:** SARAH STARKEL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (248) 680-8121

## Contact information

- **Practice address:** 10415 GRAND RIVER RD, 100, BRIGHTON, MI 48116-6533
- **Practice address phone:** (810) 227-1020
- **Mailing address:** 28000 DEQUINDRE RD, WARREN, MI 48092-2468
- **Mailing address phone:** (248) 680-8000
- **Mailing address fax:** (248) 292-3852

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | MI | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | MI | — |

## Other

- **Enumeration date:** 02/14/2012
- **Last updated:** 06/28/2022