# ASCENSION PROVIDENCE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TeleMedicine/Virtual Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730575085
- **Authorized official:** SARAH STARKEL (SUPERVISOR, ENROLLMENT)
- **Authorized official phone:** (248) 680-8121

## Contact information

- **Practice address:** 16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
- **Practice address phone:** (248) 849-2561
- **Practice address fax:** (248) 849-8313
- **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 |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | 4301059442 | MI | — |
| 207R00000X | Internal Medicine Physician | 4301056134 | MI | Yes |
| 207RI0011X | Interventional Cardiology Physician | 4301058284 | MI | — |
| 207RP1001X | Pulmonary Disease Physician | 4301067318 | MI | — |
| 2084N0400X | Neurology Physician | 4301055579 | MI | — |

## Other

- **Enumeration date:** 04/14/2015
- **Last updated:** 06/28/2022