Healthcare Provider Details

I. General information

NPI: 1114334422
Provider Name (Legal Business Name): SYNERGY SURGICALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300A FAUNCE CORNER RD
NORTH DARTMOUTH MA
02747-1280
US

IV. Provider business mailing address

PO BOX 843524
DALLAS TX
75284-3524
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-2211
  • Fax: 508-973-1105
Mailing address:
  • Phone:
  • Fax:

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: VICE PRESIDENT
Credential: MD
Phone: 773-425-3562