Provider Demographics
NPI:1861832578
Name:MICHIGAN SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MICHIGAN SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADI
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-673-5997
Mailing Address - Street 1:7350 HORGER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1424
Mailing Address - Country:US
Mailing Address - Phone:313-673-5997
Mailing Address - Fax:734-722-4815
Practice Address - Street 1:3106 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1221
Practice Address - Country:US
Practice Address - Phone:734-722-6300
Practice Address - Fax:734-722-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017213208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty