Healthcare Provider Details

I. General information

NPI: 1750411856
Provider Name (Legal Business Name): SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21230 DEQUINDRE RD SOUTHEAST MICHIGAN SURGICAL HOSPITAL
WARREN MI
48091
US

IV. Provider business mailing address

21230 DEQUINDRE RD SOUTHEAST MICHIGAN SURGICAL HOSPITAL
WARREN MI
48091
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5677490001
License Number StateMI

VIII. Authorized Official

Name: MRS. ROBIN COLE
Title or Position: DIRECTOR
Credential:
Phone: 810-275-9333