Provider Demographics
NPI:1588824866
Name:NORTHERN MACOMB SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:NORTHERN MACOMB SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-416-7575
Mailing Address - Street 1:17700 23 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1154
Mailing Address - Country:US
Mailing Address - Phone:586-416-7569
Mailing Address - Fax:586-416-7571
Practice Address - Street 1:17700 23 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1154
Practice Address - Country:US
Practice Address - Phone:586-416-7569
Practice Address - Fax:586-416-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI506857261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical