Provider Demographics
NPI:1194925081
Name:SURGICAL ASSOCIATES OF LUDINGTON PC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF LUDINGTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:UMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-843-3717
Mailing Address - Street 1:7 N ATKINSON DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1953
Mailing Address - Country:US
Mailing Address - Phone:231-843-3717
Mailing Address - Fax:231-845-6198
Practice Address - Street 1:7 N ATKINSON DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1953
Practice Address - Country:US
Practice Address - Phone:231-843-3717
Practice Address - Fax:231-845-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2840869Medicaid
MI0N93560Medicare PIN