Provider Demographics
NPI:1083661656
Name:MACOMB SURGICAL SPECIALISTS,PLC
Entity Type:Organization
Organization Name:MACOMB SURGICAL SPECIALISTS,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-393-7777
Mailing Address - Street 1:27472 SCHOENHERR RD
Mailing Address - Street 2:STE #150
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6688
Mailing Address - Country:US
Mailing Address - Phone:586-393-7777
Mailing Address - Fax:586-777-1533
Practice Address - Street 1:27472 SCHOENHERR RD
Practice Address - Street 2:STE #150
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6688
Practice Address - Country:US
Practice Address - Phone:586-393-7777
Practice Address - Fax:586-777-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083661656Medicare UPIN