=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811226244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGICAL INSTITUTE OF MICHIGAN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2009
-----------------------------------------------------
Last Update Date | 03/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33545 CHERRY HILL RD STE 200
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48186-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-729-7960
-----------------------------------------------------
Fax | 734-729-7969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33545 CHERRY HILL RD STE 200
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48186-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-729-7960
-----------------------------------------------------
Fax | 734-729-7969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SCHEDULER
-----------------------------------------------------
Name | MARIA SWITALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-729-7960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------