Organization
ASCENSION MEDICAL GROUP PROMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIN HOUGHTON (CFO)
(269) 226-4800
Entity
Organization
Contact information
Practice address
1555 E CHICAGO RD, STURGIS, MI 49091-1993
(269) 651-7114
Mailing address
1717 SHAFFER ST STE 2, KALAMAZOO, MI 49048-1623
(269) 552-2836
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350C910110
BCBSM
—
Enumeration date
08/07/2006
Last updated
12/30/2022
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