Provider Demographics
NPI:1942942511
Name:SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Other - Org Name:INSIGHT OUTPATIENT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:NADIR
Authorized Official - Last Name:IJAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-275-9371
Mailing Address - Street 1:21230 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2279
Mailing Address - Country:US
Mailing Address - Phone:810-275-9333
Mailing Address - Fax:
Practice Address - Street 1:21230 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2279
Practice Address - Country:US
Practice Address - Phone:810-275-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy