Provider Demographics
NPI:1225101660
Name:MUSKEGON SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:MUSKEGON SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZONCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-739-9461
Mailing Address - Street 1:1316 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1835
Mailing Address - Country:US
Mailing Address - Phone:231-739-9461
Mailing Address - Fax:231-733-8131
Practice Address - Street 1:1316 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1835
Practice Address - Country:US
Practice Address - Phone:231-739-9461
Practice Address - Fax:231-733-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208200000X, 208600000X, 2086S0129X, 332B00000X
MI5201006378225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE6022OtherMEDICARE RR
OP01830Medicare ID - Type Unspecified