Provider Demographics
NPI:1396817714
Name:MICHIGAN PEDIATRIC SURGERY ASSOCIATES P.C.
Entity type:Organization
Organization Name:MICHIGAN PEDIATRIC SURGERY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SADLOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC CGSC
Authorized Official - Phone:313-831-0459
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-831-3220
Mailing Address - Fax:313-831-3908
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-831-3220
Practice Address - Fax:313-831-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020H277290OtherBCBS OF MI GROUP ID
MI020H277290OtherBCBS OF MI GROUP ID