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General NPI Number Information
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NPI Number | 1316939952
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Entity Type | Organization
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Legal Business Name | MICHIGAN SURGERY SPECIALISTS, P.C.
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 11012 THIRTEEN MILE ROAD SUITE 111
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-558-8470
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Fax | 586-558-8481
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Provider Business Mailing Address
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Address Line | 31201 CHICAGO RD S STE C302
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City | WARREN
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State | MI
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Zip | 48093-5553
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Country | US
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Telephone | 586-582-0864
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Fax | 586-582-0964
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MICHELE KUDLOR
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Credential |
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Telephone | 586-459-5592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301046061
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | 4301046061
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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