Provider Demographics
NPI:1760770903
Name:ASSOCIATED SURGICAL CENTER OF DEARBORN LLC
Entity Type:Organization
Organization Name:ASSOCIATED SURGICAL CENTER OF DEARBORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-202-9400
Mailing Address - Street 1:24420 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3233
Mailing Address - Country:US
Mailing Address - Phone:734-673-5917
Mailing Address - Fax:314-667-6915
Practice Address - Street 1:24420 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3233
Practice Address - Country:US
Practice Address - Phone:734-673-5917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDH1373OtherRR PTAN