Healthcare Provider Details

I. General information

NPI: 1154208445
Provider Name (Legal Business Name): CADILLAC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 S US 131 HWY
CADILLAC MI
49601
US

IV. Provider business mailing address

7665 S US 131 HWY
CADILLAC MI
49601
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-7411
  • Fax:
Mailing address:
  • Phone: 231-876-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER EDWARD MARINOFF
Title or Position: PRESIDENT/CEO SOUTH REIGON
Credential:
Phone: 231-352-2285