Healthcare Provider Details

I. General information

NPI: 1679605570
Provider Name (Legal Business Name): SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

IV. Provider business mailing address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

V. Phone/Fax

Practice location:
  • Phone: 586-427-1000
  • Fax: 586-759-0237
Mailing address:
  • Phone: 586-427-1000
  • Fax: 586-759-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. NADIR IJAZ
Title or Position: DIRECTOR
Credential:
Phone: 810-275-9371