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General NPI Number Information
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NPI Number | 1588824866
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Entity Type | Organization
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Legal Business Name | NORTHERN MACOMB SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 17700 23 MILE RD SUITE 200
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City | MACOMB
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State | MI
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Zip | 48044-1154
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Country | US
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Telephone | 586-416-7569
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Fax | 586-416-7571
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Provider Business Mailing Address
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Address Line | 17700 23 MILE RD SUITE 200
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City | MACOMB
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State | MI
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Zip | 48044-1154
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Country | US
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Telephone | 586-416-7569
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Fax | 586-416-7571
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | DR. CHERYL WESEN
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Credential | MD
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Telephone | 586-416-7575
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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 | 506857
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License Number State | MI
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