Provider Demographics
NPI:1437334257
Name:SOUTHEAST MICHIGAN NEUROSURGERY PLLC
Entity Type:Organization
Organization Name:SOUTHEAST MICHIGAN NEUROSURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-551-3020
Mailing Address - Street 1:3535 WEST 13 MILE ROAD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-3020
Mailing Address - Fax:248-551-3019
Practice Address - Street 1:3535 WEST 13 MILE ROAD
Practice Address - Street 2:SUITE 504
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-3020
Practice Address - Fax:248-551-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050230207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI140F344180OtherBCBSM
MI2769781-10Medicaid
MIPTAN P00455528OtherMEDICARE RAILROAD
MIDG8023OtherMEDICARE RAILROAD
MIOP52120OtherPTAN
MIOP52120OtherPTAN
MIPTAN P00455528OtherMEDICARE RAILROAD