Provider Demographics
NPI:1528011921
Name:MID MICHIGAN SURGICAL SPECIALISTS P C
Entity Type:Organization
Organization Name:MID MICHIGAN SURGICAL SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-4855
Mailing Address - Street 1:5415 FASHION SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-8200
Mailing Address - Country:US
Mailing Address - Phone:989-790-4855
Mailing Address - Fax:989-790-7335
Practice Address - Street 1:5415 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-8200
Practice Address - Country:US
Practice Address - Phone:989-790-4855
Practice Address - Fax:989-790-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty