Organization · NPI-2

Michigan Cosmetic & Reconstructive

Plastic Surgery · Southfield, MI

NPI number1699805556
StatusActive
Last updated in NPPESApr 20, 2008

Details

NPI
1699805556
Entity type
Organization (NPI-2)
Legal business name
Michigan Cosmetic & Reconstructive
Organization subpart
No
Enumeration date
Mar 7, 2007
Last updated
Apr 20, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208200000X Plastic Surgery4301082433MIYes

Practice location

30603 Southfield Rd
Southfield, MI 48076-7729

Phone 248-540-1900 · Fax 248-767-8706

Mailing address

30603 Southfield Rd
Southfield, MI 48076-7729

Phone 248-540-1900 · Fax 248-767-8706

Authorized official

Mariam H Awada
Owner
2485401900

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