Provider Demographics
NPI:1386735223
Name:MIDWESTERN SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:MIDWESTERN SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-1001
Mailing Address - Street 1:999 S WASHINGTON AVENUE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601
Mailing Address - Country:US
Mailing Address - Phone:989-790-1001
Mailing Address - Fax:989-790-1002
Practice Address - Street 1:999 S WASHINGTON AVENUE
Practice Address - Street 2:SUITE #2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-790-1001
Practice Address - Fax:989-790-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020G310680OtherBLUE CROSS BLUE SHIELD
MI020G310680OtherBLUE CROSS BLUE SHIELD
MI6261510001Medicare NSC