Provider Demographics
NPI:1649393950
Name:ACADEMIC SURGERY PROGRAM, P.C.
Entity Type:Organization
Organization Name:ACADEMIC SURGERY PROGRAM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOSHAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:734-712-3971
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 2115
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-3971
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 2115
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVH026433173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty