SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC (NPI# 1295865392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295865392 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC |
| Other Organization Name | SOUTHEAST MICHIGAN SURGICAL HOSPITAL |
| Practice Address |
21230 Dequindre Rd Warren MI 48091-2279 |
| Practice Telephone | 5864271000 |
| Practice Fax Number | 5867590237 |
| Mailing Telephone | 5864271000 |
| Mailing Fax Number | 5867590237 |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2013-04-12 |
| Authorized Official Name | MR. JEFFREY A POULSEN (CFO) |
| Authorized Official Telephone | 5864271000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| Y | 213E00000X | Podiatrist | 500100 | MI | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS PROVIDER ID # | 0E01458 | 01 |
| MI | PODIATRIST GROUP ID # | 0E00146 | 01 |
| MI | 2619390 | 05 |
| Other Name | Type Code |
|---|---|
| SOUTHEAST MICHIGAN SURGICAL HOSPITAL | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962402354 | Southeast Michigan Surgical Hospital, LLC | General Acute Care Hospital | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2005-07-28 |
| 1679605570 | Southeast Michigan Surgical Hospital, LLC | Specialist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2007-03-09 |
| Street Address |
21230 DEQUINDRE RD |
| City | WARREN |
| State | MI |
| Zip Code | 48091-2279 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962402354 | Southeast Michigan Surgical Hospital, LLC | General Acute Care Hospital | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2005-07-28 |
| 1548895550 | Insight Urgent Care PC | Clinic/Center | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2020-03-10 |
| 1477049260 | Alexander Icardi | Podiatrist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2018-07-05 |
| 1487140521 | William Alexander Carter | Podiatrist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2018-07-02 |
| 1073008371 | Firras Garada | Podiatrist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2018-06-28 |
| 1801305198 | Tricia Ann Haener | Registered Nurse | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2017-09-29 |
| 1588180509 | Joshua Bennett | Dietitian, Registered | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2017-08-22 |
| 1801311030 | Susan Marie Vendemelio | Pharmacist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2017-08-09 |
| 1629593868 | Patrick Brien Butters | Pharmacist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2017-08-09 |
| 1477074904 | Seyed Sadegh Arab | Podiatrist | 21230 Dequindre Rd, Warren, MI 48091-2279 | 2017-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548615172 | Amanda Lynn Kelsey | Nurse Practitioner | 21647 Ryan Road, Warren, MI 48091 | 2016-05-02 |
| 1902284474 | Daejana Maldonado | Licensed Practical Nurse | 7519 Toepfer, Warren, MI 48091 | 2015-05-15 |
| 1245637743 | Jerami Roy | Recreation Therapist | 7086 E 9 Mile, Warren, MI 48091 | 2014-11-26 |
| 1265698344 | Amanda Sarah Yousif-mansour | Dentist | 2442 E 10 Mile Road, Warren, MI 48091 | 2008-07-29 |
| 1326171166 | Sunshine Dental Center PC | Dentist | 21761 Ryan Rd, Warren, MI 48091 | 2007-03-13 |
| 1487709630 | Albert Spickers | General Practice | 26193 Meredith Drive, Warren, MI 48091 | 2007-01-25 |
| 1487706859 | Rita Jean Rose | Physician Assistant | 2104 E. 11 Mile Road, Suite 600, Warren, MI 48091 | 2007-01-17 |
| 1790835452 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 2000 Ten Mile Rd., Warren, MI 48091 | 2007-01-12 |
| 1942363759 | Carolyn Joan Sucaet | Physical Therapist | 20952 12 Mile Road, Suite 110, St. Clair Shores, FM 48091 | 2006-12-19 |
| 1013070135 | Mcnichols Xray Clinic PC | Radiology | 21230 Dequindre Road, Southeast Michigan Surgical Hospital, Warren, MI 48091 | 2006-12-19 |
| Find all providers in zip 48091 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679185227 | Richard S Klimecki Dpm | Podiatrist | 30205 Schoenherr Rd Ste A, Warren, MI 48088-6800 | 2020-08-17 |
| 1598949273 | Austintown Podiatry Associates Inc | Podiatrist | 3802 Elm Rd Ne, Warren, OH 44483-2600 | 2007-12-18 |
| 1972689586 | Nicholas Bradlee Dpm | Podiatrist | 28565 Ryan Road, Warren, MI 48092 | 2006-10-27 |
| 1891880845 | Donald M Solomon | Podiatrist | 23423 Ryan, Donald Solomon Dpm, Warren, MI 48091-1927 | 2006-10-04 |
| 1316041742 | Foot Specialists, PC | Podiatrist | 11995 E 12 Mile Rd, Ste 202b, Warren, MI 48093 | 2006-09-07 |
| 1275544132 | Rita Liebson | Podiatrist | 6 Hill Hollow Rd, Warren, NJ 07059-5535 | 2006-08-10 |
| 1023085313 | Michael Guy Warshaw | Podiatrist | 2537 E Market St, Warren, OH 44483-6257 | 2006-03-05 |
| 1699745430 | Daniel C Aronovitz | Podiatrist | 31730 Hoover Rd, Suite B, Warren, MI 48093 | 2006-01-24 |
| 1831169853 | Downriver Podiatrists, P.C. | Podiatrist | 31730 Hoover Rd Ste B, Warren, MI 48093 | 2006-01-23 |
| 1811970429 | Richard S Klimecki | Podiatrist | 30205 Schoenherr, Suite A, Warren, MI 48088 | 2005-11-29 |
| Find all providers in WARREN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.