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General NPI Number Information
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NPI Number | 1962402354
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Entity Type | Organization
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Legal Business Name | SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 21230 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48091-2279
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Country | US
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Telephone | 586-427-1000
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Fax | 586-759-0237
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Provider Business Mailing Address
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Address Line | 21230 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48091-2279
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Country | US
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Telephone | 586-427-1000
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Fax | 586-759-0237
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. NADIR IJAZ
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Credential |
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Telephone | 810-275-9371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 500100
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License Number State | MI
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