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NPI Code Detail

MEDICARE: MCCI-MICHIGAN CENTER FOR SURGICAL SPECIALISTS

MEDICARE: MCCI-MICHIGAN CENTER FOR SURGICAL SPECIALISTS
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
1208600000XSurgery Physician

General Provider Information

NPI Number : 1851366041
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCCI-MICHIGAN CENTER FOR SURGICAL SPECIALISTS
Provider Business Mailing Address
First Line : 28500 ORCHARD LAKE RD
Second Line : SUITE 201
City : FARMINGTON HILLS
State : MI
Zip : 48334-2936
Country : US
Telephone Number : 248-865-2575
Fax Number : 248-865-2590
Provider Business Practice Location Address
First Line : 28500 ORCHARD LAKE RD
Second Line : SUITE 201
City : FARMINGTON HILLS
State : MI
Zip : 48334-2936
Country : US
Telephone Number : 248-865-2575
Fax Number : 248-865-2590
Authorized Official
Title or Position : CEO
Name : FARIDEH R. BAGNE
Credential : PH.D., J.D.
Telephone Number : 248-338-0300
Provider Enumeration Date : 02/21/2006
Last Update Date : 08/22/2020

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