Provider Demographics
NPI:1457591174
Name:SELECT SURGICAL PLLC
Entity Type:Organization
Organization Name:SELECT SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-466-6230
Mailing Address - Street 1:1030 HARRINGTON ST
Mailing Address - Street 2:103
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-466-6230
Mailing Address - Fax:586-493-3828
Practice Address - Street 1:1030 HARRINGTON ST
Practice Address - Street 2:103
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-466-6230
Practice Address - Fax:586-493-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-21
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008358208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0MI1490Medicare PIN
MI=========OtherTAX ID
MI0MI1490Medicare PIN
MI1295725620Medicaid