Healthcare Provider Details

I. General information

NPI: 1851877153
Provider Name (Legal Business Name): MICHIGAN SURGERY SPECIALISTS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date: 01/07/2019
Reactivation Date: 01/30/2019

III. Provider practice location address

11012 E 13 MILE RD STE 200
WARREN MI
48093-2547
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 200
WARREN MI
48093-2547
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8890
  • Fax: 586-573-2706
Mailing address:
  • Phone: 586-558-9705
  • Fax: 586-558-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHELE L KUDLOR
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 586-558-9705