Provider Demographics
NPI:1265706584
Name:FLINT SURGICAL GROUP PC
Entity type:Organization
Organization Name:FLINT SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDELMAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:JONDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-0368
Mailing Address - Street 1:1020 CHARTER DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLNT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3584
Mailing Address - Country:US
Mailing Address - Phone:810-720-0368
Mailing Address - Fax:810-720-0371
Practice Address - Street 1:1020 CHARTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-720-0368
Practice Address - Fax:810-720-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3314472Medicaid
MI3207605Medicaid
MI4356904Medicaid
MI3207599Medicaid
MIG40871Medicare UPIN
MIH53024Medicare UPIN
MI3314472Medicaid
MI3207605Medicaid