Provider Demographics
NPI:1205408093
Name:ASCEND MEDICAL MICHIGAN II PC
Entity Type:Organization
Organization Name:ASCEND MEDICAL MICHIGAN II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-500-8010
Mailing Address - Street 1:3560 LENOX RD NE STE 1230
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-4266
Mailing Address - Country:US
Mailing Address - Phone:404-947-8066
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWN CTR STE 660
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1199
Practice Address - Country:US
Practice Address - Phone:404-947-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty