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NPI Code Detail

MEDICARE: NORTHERN MACOMB SURGICAL CENTER, LLC

MEDICARE: NORTHERN MACOMB SURGICAL CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center506857MI

General Provider Information

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

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Directions to “NORTHERN MACOMB SURGICAL CENTER, LLC ” Practice Location

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