Provider Demographics
NPI:1710040068
Name:NORTHWEST SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTHWEST SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TELMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-353-0200
Mailing Address - Street 1:27209 LAHSER
Mailing Address - Street 2:SUITE 128
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8402
Mailing Address - Country:US
Mailing Address - Phone:248-353-0200
Mailing Address - Fax:243-353-1513
Practice Address - Street 1:27209 LAHSER
Practice Address - Street 2:SUITE 128
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8402
Practice Address - Country:US
Practice Address - Phone:248-353-0200
Practice Address - Fax:243-353-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty