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General NPI Number Information
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NPI Number | 1194925081
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF LUDINGTON PC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 7 N ATKINSON DR SUITE 112
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City | LUDINGTON
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State | MI
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Zip | 49431-1953
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Country | US
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Telephone | 231-843-3717
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Fax | 231-845-6198
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Provider Business Mailing Address
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Address Line | 7 N ATKINSON DR SUITE 112
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City | LUDINGTON
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State | MI
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Zip | 49431-1953
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Country | US
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Telephone | 231-843-3717
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Fax | 231-845-6198
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIZAR A UMRAN
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Credential | MD
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Telephone | 231-843-3717
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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 | 4301033140
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License Number State | MI
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