Provider Demographics
NPI:1699812214
Name:SURGE, ERIC (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SURGE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 GETZ RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5727
Mailing Address - Country:US
Mailing Address - Phone:231-798-0139
Mailing Address - Fax:
Practice Address - Street 1:1545 GETZ RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-5727
Practice Address - Country:US
Practice Address - Phone:231-798-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer