Provider Demographics
NPI:1124208335
Name:OAKLAND MACOMB SURGICAL GROUP PLLC
Entity Type:Organization
Organization Name:OAKLAND MACOMB SURGICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-546-2600
Mailing Address - Street 1:27483 DEQUINDRE
Mailing Address - Street 2:#301
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-546-2600
Mailing Address - Fax:248-546-2604
Practice Address - Street 1:27483 DEQUINDRE
Practice Address - Street 2:#301
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-546-2600
Practice Address - Fax:248-546-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N77140Medicare PIN