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General NPI Number Information
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NPI Number | 1841840113
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Entity Type | Organization
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Legal Business Name | THORACIC SURGICAL SERVICES, PC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 4100 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-2013
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Country | US
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Telephone | 248-676-2582
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Fax |
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Provider Business Mailing Address
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Address Line | 2186 CRANE ST
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City | WATERFORD
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State | MI
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Zip | 48329-3721
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Country | US
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Telephone | 248-296-0118
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | PATRICIA WALL
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Credential |
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Telephone | 248-296-0118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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