Provider Demographics
NPI:1649752650
Name:PIONEER ENDOSCOPY & SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:PIONEER ENDOSCOPY & SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-215-7476
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48311-0370
Mailing Address - Country:US
Mailing Address - Phone:586-771-0270
Mailing Address - Fax:586-343-8870
Practice Address - Street 1:36401 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2763
Practice Address - Country:US
Practice Address - Phone:586-757-6400
Practice Address - Fax:586-757-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical