Healthcare Provider Details

I. General information

NPI: 1881165157
Provider Name (Legal Business Name): MICHIGAN SURGERY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22731 NEWMAN ST STE 100A
DEARBORN MI
48124-2031
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 112
WARREN MI
48093-2546
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-4910
  • Fax: 313-561-8561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ODDO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 586-806-8726