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General NPI Number Information
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NPI Number | 1366574410
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Entity Type | Organization
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Legal Business Name | NEW MILLENNIUM SURGERY CENTER, PLLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 29201 TELEGRAPH RD SUITE 315
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1331
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Country | US
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Telephone | 248-281-0028
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Fax | 248-281-0034
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Provider Business Mailing Address
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Address Line | 29201 TELEGRAPH RD SUITE 315
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1331
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Country | US
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Telephone | 248-281-0028
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Fax | 248-281-0034
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BETTY VANDEPUTTE
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Credential |
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Telephone | 248-281-0028
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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 | 636926
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License Number State | MI
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