Healthcare Provider Details

I. General information

NPI: 1053439117
Provider Name (Legal Business Name): OUTPATIENT ENDOSCOPY & SURGI CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28300 HARPER AVE
SAINT CLAIR SHORES MI
48081-1686
US

IV. Provider business mailing address

28300 HARPER AVE
SAINT CLAIR SHORES MI
48081-1686
US

V. Phone/Fax

Practice location:
  • Phone: 586-778-6090
  • Fax: 586-778-1943
Mailing address:
  • Phone: 586-778-6090
  • Fax: 586-778-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number506821
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number506821
License Number StateMI

VIII. Authorized Official

Name: DR. HARIVALLABH D PANDYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-778-6090