Provider Demographics
NPI:1619004488
Name:SYNERGY MEDICAL EDUCATION ALLIANCE
Entity Type:Organization
Organization Name:SYNERGY MEDICAL EDUCATION ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:AQUINAS
Authorized Official - Last Name:RASKAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-583-6828
Mailing Address - Street 1:5877 AMBASSADOR DR
Mailing Address - Street 2:APT #2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3550
Mailing Address - Country:US
Mailing Address - Phone:989-790-7472
Mailing Address - Fax:
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084425282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen