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General NPI Number Information
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NPI Number | 1154208445
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Entity Type | Organization
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Legal Business Name | CADILLAC SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 7665 S US 131 HWY
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City | CADILLAC
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State | MI
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Zip | 49601
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Country | US
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Telephone | 231-876-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 7665 S US 131 HWY
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City | CADILLAC
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State | MI
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Zip | 49601
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Country | US
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Telephone | 231-876-7411
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO SOUTH REIGON
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Name | PETER EDWARD MARINOFF
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Credential |
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Telephone | 231-352-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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