MEDICARE: MICHIGAN SURGERY SPECIALISTS, P.C.

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
1	332900000X	Non-Pharmacy Dispensing Site

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22731	OTHER	MI	MDSCRIPTS

General Provider Information

NPI Number	:	1881165157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN SURGERY SPECIALISTS, P.C.

Provider Business Mailing Address
First Line	:	11012 E 13 MILE RD STE 112
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-2546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22731 NEWMAN ST STE 100A
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2031
Country	:	US
Telephone Number	:	313-561-4910
Fax Number	:	313-561-8561

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DANIEL ODDO
Credential	:
Telephone Number	:	586-806-8726

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	08/25/2023

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