Provider Demographics
NPI:1255490397
Name:MACATAWA SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:MACATAWA SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-994-6677
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT 77138
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0138
Mailing Address - Country:US
Mailing Address - Phone:616-994-6677
Mailing Address - Fax:616-994-6683
Practice Address - Street 1:3290 N WELLNESS DR STE 150
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8047
Practice Address - Country:US
Practice Address - Phone:616-994-6677
Practice Address - Fax:616-994-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N58020Medicare ID - Type UnspecifiedMEDICARE