Provider Demographics
NPI:1841059854
Name:12 MILE SURGERY CENTER, PLLC
Entity type:Organization
Organization Name:12 MILE SURGERY CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-343-8717
Mailing Address - Street 1:29000 LITTLE MACK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3018
Mailing Address - Country:US
Mailing Address - Phone:586-343-8717
Mailing Address - Fax:586-343-8773
Practice Address - Street 1:29000 LITTLE MACK AVE STE C
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3018
Practice Address - Country:US
Practice Address - Phone:586-343-8717
Practice Address - Fax:586-343-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty