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1083663652 NPI number — MEMAC ASSOCIATES, PC

NPI Number: 1083663652
Health Care Provider/Practitioner: MEMAC ASSOCIATES, PC

Information about “1083663652” NPI (MEMAC ASSOCIATES, PC) exists in 1083663652 in HTML format HTML  |  1083663652 in plain Text format TXT  |  1083663652 in PDF (Portable Document Format) PDF  |  1083663652 in an XML format XML  formats.

NPI Number : 1083663652 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083663652",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MEMAC ASSOCIATES, PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7 W SQUARE LAKE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLOOMFIELD HILLS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48302-0462",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-573-5260",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11800 E 12 MILE RD",
    "SecondLinePracticeLocationAddress": "ANESTHESIA DEPARTMENT",
    "PracticeLocationAddressCityName": "WARREN",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48093-3472",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-573-5260",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/09/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LARDO",
    "AuthorizedOfficialFirstName": "HORACIO",
    "AuthorizedOfficialMiddleName": "G.",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "586-573-5267",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207LP2900X",
          "TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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