Provider Demographics
NPI:1306029426
Name:DIX EUREKA MEDICAL CENTER PC
Entity Type:Organization
Organization Name:DIX EUREKA MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SITARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-320-0071
Mailing Address - Street 1:14797 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2507
Mailing Address - Country:US
Mailing Address - Phone:734-281-9950
Mailing Address - Fax:734-281-4998
Practice Address - Street 1:14797 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2507
Practice Address - Country:US
Practice Address - Phone:734-281-9950
Practice Address - Fax:734-281-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3365758Medicaid
MIP10210001Medicare PIN
MIOP10210Medicare PIN