Basic Information
| Provider Information | |||||||||
| NPI: | 1619004488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGY MEDICAL EDUCATION ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5877 AMBASSADOR DR | ||||||||
| Address2: | APT #2 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897907472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 HOUGHTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486025303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895836828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RASKAUSKAS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | AQUINAS | ||||||||
| AuthorizedOfficialTitleorPosition: | PROM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9895836828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NW0100X | 4301084425 | MI | Y | Hospitals | General Acute Care Hospital | Women |
No ID Information.