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SOUTHEAST MICHIGAN SURGICAL HOSPITAL
NPI 1295865392
Podiatrist in Warren, MI

Active since March 07, 2007CLIA 23D1022232 · Accreditation
21230 DEQUINDRE RD, WARREN, MI 48091(586) 427-1000(586) 759-0237 Get Directions Write a Review

NPPES record last updated: April 12, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southeast Michigan Surgical Hospital NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST MICHIGAN SURGICAL HOSPITAL (NPI 1295865392) is a healthcare organization registered as a podiatrist in Warren, Michigan and active in the NPI registry since March 2007. The organization holds an CLIA Accreditation certificate valid through July 2, 2027 and lists Jeffrey A Poulsen, Cfo, as its authorized official.

NPPES Registry Identity

NPI1295865392
Entity TypeOrganization
Primary Taxonomy213E00000X
Legal Business NameSOUTHEAST MICHIGAN SURGICAL HOSPITAL, LLC
Location Address21230 DEQUINDRE RDWarren, MI 48091-2279
Mailing Address21230 Dequindre RdWarren, MI 48091-2279 · (586) 427-1000 · Fax (586) 759-0237
Phone(586) 427-1000
Fax(586) 759-0237
Organization SubpartNo
Authorized OfficialJeffrey A PoulsenCfo · (586) 427-1000
Enumeration DateMarch 7, 2007
Last NPPES UpdateApril 12, 2013
✔ NPI 1295865392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatristPodiatric Medicine & Surgery Service Providers
Taxonomy Code213E00000X
License✔ Licensed in MI · 500100
Definition
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.
21230 DEQUINDRE RD, Warren, MI 48091
Open in Google Maps ↗

Other Names 1

Doing Business AsSoutheast Michigan Surgical Hospital

Other Identifiers 5

Medicaid2619390MI
Other0E00146MI · Podiatrist Group Id #
Medicare ID-Type Unspecified0N79800MI · Podiatrist
Other0E01458MI · Bcbs Provider Id #
Medicare UPINON79780

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 23D1022232

Southeast Michigan Surgical Hospital LLC · Warren, MI
Active · expires Jul 2, 2027
CLIA Number23D1022232
Laboratory TypeHospital
Certificate Effective DateJuly 3, 2025
Certificate Expiration DateJuly 2, 2027
Laboratory DirectorMohamed Elfakharany
Laboratory Phone(586) 880-2450
Laboratory LocationSoutheast Michigan Surgical Hospital LLC21230 Dequindre Road, Warren, MI 48091
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. ROMULO GASMEN PASCUA CRNA
Nurse Anesthetist, Certified Registered
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (734) 765-2921
FIRRAS GARADA DPM
Podiatrist (Foot & Ankle Surgery)
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (586) 427-1000
TRIPLE-M MEDICAL INC
Durable Medical Equipment & Medical Supplies
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (810) 275-9333
MRS. NELLIE BRUNO LEWIS CRNA
Nurse Anesthetist, Certified Registered
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (586) 880-2485
JAWAD A SHAH MD PC
Durable Medical Equipment & Medical Supplies
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (810) 275-9333
EMMA KRISTINE MANDOUH NP
Nurse Practitioner
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (586) 427-1000
ABDULMALIK ALOLOFI CAA
Anesthesiologist Assistant
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (734) 306-7036
MARIA DOAN D.P.M.
Podiatrist (Foot & Ankle Surgery)
21230 DEQUINDRE RD
WARREN, MI 48091
Macomb County (586) 427-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast Michigan Surgical Hospital, LLC's NPI number?

The NPI number for Southeast Michigan Surgical Hospital, LLC is 1295865392. It was assigned to this organization in the NPPES registry on March 7, 2007. The provider is doing business as Southeast Michigan Surgical Hospital.

Where is Southeast Michigan Surgical Hospital, LLC located?

Southeast Michigan Surgical Hospital, LLC is located at 21230 Dequindre Rd, Warren, MI 48091. The listed phone number is (586) 427-1000.

What is Southeast Michigan Surgical Hospital, LLC's specialty?

The primary specialty registered for this NPI is Podiatrist with taxonomy code 213E00000X.

Does Southeast Michigan Surgical Hospital, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 23D1022232) is associated with this NPI, valid through July 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southeast Michigan Surgical Hospital, LLC accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Southeast Michigan Surgical Hospital, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southeast Michigan Surgical Hospital, LLC was last updated on April 12, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.