Healthcare Provider Details

I. General information

NPI: 1316939952
Provider Name (Legal Business Name): MICHIGAN SURGERY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date: 07/10/2008
Reactivation Date: 11/17/2008

III. Provider practice location address

11012 THIRTEEN MILE ROAD SUITE 111
WARREN MI
48093
US

IV. Provider business mailing address

31201 CHICAGO RD S STE C302
WARREN MI
48093-5553
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-8470
  • Fax: 586-558-8481
Mailing address:
  • Phone: 586-582-0864
  • Fax: 586-582-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301046061
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number4301046061
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE KUDLOR
Title or Position: BILLING MANAGER
Credential:
Phone: 586-459-5592