Healthcare Provider Details

I. General information

NPI: 1932623782
Provider Name (Legal Business Name): SYNERGY SURGICALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GLASSON WAY STE L30
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

PO BOX 843512
DALLAS TX
75284-3512
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-6696
  • Fax: 530-274-6697
Mailing address:
  • Phone: 858-759-7656
  • Fax: 858-201-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MAKOWIEC
Title or Position: OWNER/CMO
Credential: MD
Phone: 773-425-3562