# MICHIGAN AMBULATORY SURGICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Specialty Surgical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790109445
- **Authorized official:** MS. JUSTINE BRECKENRIDGE CORDAY (ADMINISTRATOR)
- **Authorized official phone:** (248) 206-2990

## Contact information

- **Practice address:** 22000 GREENFIELD RD, OAK PARK, MI 48237-2500
- **Practice address phone:** (248) 206-2990
- **Practice address fax:** (248) 206-2991
- **Mailing address:** 22000 GREENFIELD RD, OAK PARK, MI 48237-2500
- **Mailing address phone:** (248) 206-2990
- **Mailing address fax:** (248) 206-2991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/14/2014
- **Last updated:** 04/14/2020