Provider Demographics
NPI:1063028728
Name:NORTHWEST SURGICAL PLC
Entity Type:Organization
Organization Name:NORTHWEST SURGICAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-596-8884
Mailing Address - Street 1:149 ALLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3270
Mailing Address - Country:US
Mailing Address - Phone:586-596-8884
Mailing Address - Fax:
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101012641OtherMI LICENSE