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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