Provider Demographics
NPI:1114139045
Name:ACADEMIC SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ACADEMIC SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHEERES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-977-3990
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-977-6243
Mailing Address - Fax:616-977-0396
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-977-6243
Practice Address - Fax:616-977-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4736850Medicaid
MI4745617Medicaid
MI4745635Medicaid
MI4745608Medicaid
MI700D11379OtherBCBS GROUP NUMBER
MIN90160002Medicare ID - Type UnspecifiedSCHOLTEN INDIVIDUAL MR
MI4745635Medicaid
MIB18045Medicare UPIN
MI0N90160Medicare ID - Type UnspecifiedMEDICARE GROUP
MI4745608Medicaid
MIA76692Medicare UPIN
MIG53702Medicare UPIN
MI4736850Medicaid
MIN90160004Medicare ID - Type UnspecifiedVANDERKOLK INDIVUDAL MR