Provider Demographics
NPI:1093901993
Name:ASL MEDICAL PC
Entity Type:Organization
Organization Name:ASL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:734-347-1462
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-0489
Mailing Address - Country:US
Mailing Address - Phone:734-347-1462
Mailing Address - Fax:810-458-4187
Practice Address - Street 1:42627 GARFIELD RD
Practice Address - Street 2:SUITE 213
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5032
Practice Address - Country:US
Practice Address - Phone:734-347-1462
Practice Address - Fax:810-458-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301021837208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3262071Medicaid
MI11285679OtherCAQH
MIB43573Medicare UPIN
MI3262071Medicaid