Provider Demographics
NPI:1881165157
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:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-806-8726
Mailing Address - Street 1:11012 E 13 MILE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22731 NEWMAN ST STE 100A
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2031
Practice Address - Country:US
Practice Address - Phone:313-561-4910
Practice Address - Fax:313-561-8561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN SURGERY SPECIALISTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22731OtherMDSCRIPTS