Healthcare Provider Details

I. General information

NPI: 1083663652
Provider Name (Legal Business Name): MEMAC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD ANESTHESIA DEPARTMENT
WARREN MI
48093-3472
US

IV. Provider business mailing address

7 W SQUARE LAKE RD
BLOOMFIELD HILLS MI
48302-0462
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5260
  • Fax:
Mailing address:
  • Phone: 586-573-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: HORACIO G. LARDO
Title or Position: PRESIDENT
Credential: MD
Phone: 586-573-5267