Provider Demographics
NPI:1649570086
Name:MICHIGAN SURGICAL GROUP
Entity Type:Organization
Organization Name:MICHIGAN SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:248-593-9780
Mailing Address - Street 1:16100 19 MILE RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1148
Mailing Address - Country:US
Mailing Address - Phone:586-286-0000
Mailing Address - Fax:586-286-0005
Practice Address - Street 1:16100 19 MILE RD STE 100B
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1148
Practice Address - Country:US
Practice Address - Phone:586-286-0000
Practice Address - Fax:586-286-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010115842085R0202X
MI5101017430208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3056329475OtherBCBS
MI0F36125Medicare PIN