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General NPI Number Information
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NPI Number | 1295816932
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Entity Type | Organization
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Legal Business Name | MACOMB SURGICAL ASSOCIATES,P.C.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 21510 HARRINGTON ST STE 102
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City | CLINTON TWP
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State | MI
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Zip | 48036-2378
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Country | US
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Telephone | 586-228-3800
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Fax | 586-228-9800
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Provider Business Mailing Address
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Address Line | 21510 HARRINGTON ST STE 102
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City | CLINTON TWP
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State | MI
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Zip | 48036-2378
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Country | US
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Telephone | 586-228-3800
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Fax | 586-228-9800
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES J GILIBERTO JR.
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Credential | DO
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Telephone | 586-228-3800
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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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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 007081
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 008771
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 013279
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License Number State | MI
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