Healthcare Provider Details

I. General information

NPI: 1457886996
Provider Name (Legal Business Name): MUSKEGON SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 PATRIOT DR
MUSKEGON MI
49444-7807
US

IV. Provider business mailing address

DEPT 2033 PO BOX 30516
LANSING MI
48909-8016
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-1933
  • Fax:
Mailing address:
  • Phone: 231-830-3982
  • Fax: 231-830-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER L POPPEMA
Title or Position: BILLING SUPERVISOR
Credential: CPC
Phone: 231-739-1916