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General NPI Number Information
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NPI Number | 1508257882
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Entity Type | Organization
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Legal Business Name | RIVERSIDE SURGICAL ASSOCIATES, PC.
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 18025 FORT ST STE B
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City | RIVERVIEW
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State | MI
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Zip | 48193-7432
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Country | US
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Telephone | 219-902-9663
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Fax |
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Provider Business Mailing Address
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Address Line | 18025 FORT ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-7432
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Country | US
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Telephone | 734-785-8251
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Fax | 734-785-8290
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY DONALD KAMINSKY
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Credential | D.O.
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Telephone | 219-902-9663
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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 | 5101017755
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License Number State | MI
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