Provider Demographics
NPI:1891708814
Name:SURGICAL CONSULTANTS PLLC
Entity Type:Organization
Organization Name:SURGICAL CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-759-2005
Mailing Address - Street 1:1030 HARRINGTON ST
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-759-2005
Mailing Address - Fax:586-759-2636
Practice Address - Street 1:1030 HARRINGTON ST
Practice Address - Street 2:302A
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-759-2005
Practice Address - Fax:586-759-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114446930Medicaid
MI114528179Medicaid
MI0E01555OtherBCBS
MI114446930Medicaid