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General NPI Number Information
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NPI Number | 1265950802
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Entity Type | Organization
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Legal Business Name | M&M SURGICAL CENTER PC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 1 CRESCENT DR. SUITE 300
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City | PHILADELPHIA
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State | PA
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Zip | 19112
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Country | US
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Telephone | 215-389-3161
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CRESCENT DR. SUITE 300
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City | PHILADELPHIA
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State | PA
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Zip | 19112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANITA MILICI
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Credential | DMD
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Telephone | 215-389-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 115913
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License Number State | PA
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