Healthcare Provider Details

I. General information

NPI: 1407539315
Provider Name (Legal Business Name): MOTOWN CHILDREN'S SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33545 CHERRY HILL RD FL 2
WESTLAND MI
48186-4842
US

IV. Provider business mailing address

33545 CHERRY HILL RD FL 2
WESTLAND MI
48186-4842
US

V. Phone/Fax

Practice location:
  • Phone: 301-349-3000
  • Fax: 301-307-5555
Mailing address:
  • Phone: 301-349-3000
  • Fax: 301-307-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFF WHEELER
Title or Position: EXEC
Credential:
Phone: 301-494-3000