Provider Demographics
NPI:1164411278
Name:MICHIGAN SURGERY SPECIALISTS P.C.
Entity type:Organization
Organization Name:MICHIGAN SURGERY SPECIALISTS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUDLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-558-9705
Mailing Address - Street 1:31201 CHICAGO RD S STE C302
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5553
Mailing Address - Country:US
Mailing Address - Phone:586-558-9705
Mailing Address - Fax:586-558-9706
Practice Address - Street 1:11012 E 13 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-573-8890
Practice Address - Fax:586-573-2706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN SURGERY SPECIALISTS P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-20
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No335E00000XSuppliersProsthetic/Orthotic Supplier
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236575OtherMEDICARE
MI1164411278Medicaid
MI30697OtherBLUE CROSS