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Organization
SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Active
Organization
SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Active
Other names
SOUTHEAST MICHIGAN SURGICAL HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY A POULSEN (CFO)
(586) 427-1000
Entity
Organization
Contact information
Practice address
21230 DEQUINDRE RD, WARREN, MI 48091-2279
(586) 427-1000
(586) 759-0237
Mailing address
21230 DEQUINDRE RD, WARREN, MI 48091-2279
(586) 427-1000
(586) 759-0237
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
500100
MI
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E00146
PODIATRIST GROUP ID #
MI
01
—
0E01458
BCBS PROVIDER ID #
MI
05
—
2619390
—
MI
Enumeration date
03/07/2007
Last updated
04/12/2013
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