Provider Demographics
NPI:1083663652
Name:MEMAC ASSOCIATES, PC
Entity Type:Organization
Organization Name:MEMAC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HORACIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:LARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-573-5267
Mailing Address - Street 1:7 W SQUARE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0462
Mailing Address - Country:US
Mailing Address - Phone:586-573-5260
Mailing Address - Fax:
Practice Address - Street 1:11800 E 12 MILE RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3472
Practice Address - Country:US
Practice Address - Phone:586-573-5260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4484310OtherAETNA
MICA9014Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI0E06085Medicare ID - Type Unspecified