Provider Demographics
NPI:1053439117
Name:OUTPATIENT ENDOSCOPY & SURGI CENTER
Entity type:Organization
Organization Name:OUTPATIENT ENDOSCOPY & SURGI CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARIVALLABH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-778-6090
Mailing Address - Street 1:28300 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1686
Mailing Address - Country:US
Mailing Address - Phone:586-778-6090
Mailing Address - Fax:586-778-1943
Practice Address - Street 1:28300 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1686
Practice Address - Country:US
Practice Address - Phone:586-778-6090
Practice Address - Fax:586-778-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI506821261QA1903X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Not Answered261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy