Provider Demographics
NPI:1093899767
Name:PLASTIC SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGHTON-REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-451-4500
Mailing Address - Street 1:220 LYON ST NW
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2208
Mailing Address - Country:US
Mailing Address - Phone:616-451-4500
Mailing Address - Fax:616-451-9077
Practice Address - Street 1:220 LYON ST NW
Practice Address - Street 2:SUITE 700
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2208
Practice Address - Country:US
Practice Address - Phone:616-451-4500
Practice Address - Fax:616-451-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16082Medicare ID - Type UnspecifiedGROUP NUMBER