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General NPI Number Information
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NPI Number | 1558072629
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Entity Type | Organization
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Legal Business Name | MICHIGAN SPECIALTY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 6886 SASHABAW ROAD
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City | CLARKSTON
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State | MI
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Zip | 48348-4732
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Country | US
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Telephone | 248-707-3112
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Fax | 248-707-3113
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Provider Business Mailing Address
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Address Line | 6886 SASHABAW ROAD
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City | CLARKSTON
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State | MI
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Zip | 48348-4732
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Country | US
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Telephone | 248-707-3112
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Fax | 248-707-3113
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AMIR-KIANOOSH FALLAHI
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Credential | MD
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Telephone | 810-953-0500
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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 |
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License Number State |
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