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General NPI Number Information
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NPI Number | 1245268234
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF FRESNO MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6191 N FRESNO ST STE 102
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City | FRESNO
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State | CA
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Zip | 93710-8612
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Country | US
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Telephone | 559-432-3439
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Fax | 559-432-3585
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Provider Business Mailing Address
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Address Line | 6191 N FRESNO ST STE 102
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City | FRESNO
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State | CA
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Zip | 93710-8612
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Country | US
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Telephone | 559-432-3439
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Fax | 559-432-3585
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CONSTANTINE A MICHAS
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Credential | M.D.
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Telephone | 559-432-3439
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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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