Provider Demographics
NPI:1629173075
Name:THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN, PLLC
Other - Org Name:CROWNE POINT ENDOSCOPY & SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DEVELOPMENT OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-953-9365
Mailing Address - Street 1:3102 MAPLE AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1220
Mailing Address - Country:US
Mailing Address - Phone:214-953-9365
Mailing Address - Fax:214-953-9366
Practice Address - Street 1:6140 HILL 23 DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3931
Practice Address - Country:US
Practice Address - Phone:214-953-9365
Practice Address - Fax:214-953-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical