Organization
ASCENSION MACOMB OAKLAND HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN JEUP (CREDENTIALING SPECIALIST)
(248) 680-8203
Entity
Organization
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(583) 573-5000
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(583) 753-0275
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06124
BLUE CROSS
—
Enumeration date
05/28/2008
Last updated
12/13/2018
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