Organization
ASCENSION MEDICAL GROUP PROMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRENE MAFFETONE (MANAGER CONTRACTING AND PAYOR RELAT)
(574) 647-1040
Entity
Organization
Contact information
Practice address
1717 SHAFFER ST, STE 124, KALAMAZOO, MI 49048-1647
(269) 344-5552
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2043
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
MI
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208800000X
Urology Physician
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720009954
—
MI
01
—
700C910600
BCBSM
—
Enumeration date
07/22/2006
Last updated
07/08/2026
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