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NPI Code Detail

MEDICARE: SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC

MEDICARE: SOUTHEAST MICHIGAN SURGICAL HOSPITAL, 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
1273R00000XPsychiatric Hospital Unit
2282N00000XGeneral Acute Care Hospital500100MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100297OTHERMIBCBS PROVIDER ID #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
300947OTHERMICAPE MEDICAL PROV ID#

General Provider Information

NPI Number : 1962402354
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Provider Business Mailing Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 586-427-1000
Fax Number : 586-759-0237
Provider Business Practice Location Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 586-427-1000
Fax Number : 586-759-0237
Authorized Official
Title or Position : DIRECTOR
Name : MR. NADIR IJAZ
Credential :
Telephone Number : 810-275-9371
Provider Enumeration Date : 07/28/2005
Last Update Date : 05/01/2025

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1164409751 — MRS. NELLIE BRUNO LEWIS CRNA
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1235117524 — JEFFREY K WINGATE MD
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1902874308 — KENNETH DARRYL KAWA CRNA
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