Organization
ASCENSION MEDICAL GROUP PROMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRENE MAFFETONE (SENIOR CONTRACT SPECIALIST)
(574) 647-1040
Entity
Organization
Contact information
Practice address
7901 ANGLING RD, PORTAGE, MI 49024-0714
(269) 552-2912
(269) 552-2835
Mailing address
3245 HEALTH DR STE 100, STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207VG0400X
Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
251J00000X
Nursing Care Agency
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/20/2006
Last updated
05/05/2026
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