Provider Demographics
NPI:1295763159
Name:ASHTON, MICHELE L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:ASHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2690 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3002
Mailing Address - Country:US
Mailing Address - Phone:269-428-2800
Mailing Address - Fax:269-428-7177
Practice Address - Street 1:2690 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3002
Practice Address - Country:US
Practice Address - Phone:269-428-2800
Practice Address - Fax:269-428-7177
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066324A207V00000X
MI4301085065207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3286538OtherCIGNA
MI07-30407OtherPHP
IN200932860Medicaid
IN000000610078OtherANTHEM BCBS
IN200932860Medicaid
MI3286538OtherCIGNA