Provider Demographics
NPI:1669109823
Name:MICHIGAN SURGERY SPECIALISTS, P.C.
Entity type:Organization
Organization Name:MICHIGAN SURGERY SPECIALISTS, P.C.
Other - Org Name:
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 1:11012 E 13 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2547
Mailing Address - Country:US
Mailing Address - Phone:115-864-5955
Mailing Address - Fax:
Practice Address - Street 1:14650 E OLD US HIGHWAY 12 STE 302
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1805
Practice Address - Country:US
Practice Address - Phone:248-450-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN SURGERY SPECIALISTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier