Healthcare Provider Details

I. General information

NPI: 1700980406
Provider Name (Legal Business Name): MICHIGAN OUTPATIENT SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33080 UTICA RD
FRASER MI
48026-2038
US

IV. Provider business mailing address

PO BOX 26010
FRASER MI
48026-6010
US

V. Phone/Fax

Practice location:
  • Phone: 586-296-7250
  • Fax: 586-296-0276
Mailing address:
  • Phone: 586-296-7250
  • Fax: 586-296-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number506810
License Number StateMI

VIII. Authorized Official

Name: MAHDI M BASHA
Title or Position: DIRECTOR
Credential: DO
Phone: 586-296-7250