Provider Demographics
NPI:1093749095
Name:MICHIGAN COLON & RECTAL SURGEONS, PC
Entity Type:Organization
Organization Name:MICHIGAN COLON & RECTAL SURGEONS, PC
Other - Org Name:MCRS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-644-3711
Mailing Address - Street 1:18161 W 13 MILE RD.
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-644-3711
Mailing Address - Fax:248-644-2864
Practice Address - Street 1:18161 W 13 MILE RD
Practice Address - Street 2:SUITE A1
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1113
Practice Address - Country:US
Practice Address - Phone:248-644-3711
Practice Address - Fax:248-644-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36140Medicare PIN