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General NPI Number Information
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NPI Number | 1083663652
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Entity Type | Organization
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Legal Business Name | MEMAC ASSOCIATES, PC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11800 E 12 MILE RD ANESTHESIA DEPARTMENT
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City | WARREN
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State | MI
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Zip | 48093-3472
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Country | US
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Telephone | 586-573-5260
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Fax |
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Provider Business Mailing Address
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Address Line | 7 W SQUARE LAKE RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0462
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Country | US
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Telephone | 586-573-5260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HORACIO G. LARDO
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Credential | MD
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Telephone | 586-573-5267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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