Provider Demographics
NPI:1316031339
Name:SURGICAL ASSOCIATES OF MACOMB, PLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MACOMB, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-5410
Mailing Address - Street 1:43331 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1109
Mailing Address - Country:US
Mailing Address - Phone:586-263-5410
Mailing Address - Fax:586-263-7131
Practice Address - Street 1:43331 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1109
Practice Address - Country:US
Practice Address - Phone:586-263-5410
Practice Address - Fax:586-263-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3426530Medicaid
MI4109780Medicaid
MI4110717Medicaid
MI4856287Medicaid
MI4207412Medicaid
MI3426512Medicaid
MI4207412Medicaid
MI3426530Medicaid
MIH16270Medicare UPIN
MI3426512Medicaid
MIH15216Medicare UPIN
MIA74296Medicare UPIN
MI4109780Medicaid