Provider Demographics
NPI:1134278401
Name:RENAISSANCE PLASTIC SURGERY P.C.
Entity Type:Organization
Organization Name:RENAISSANCE PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEFANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-779-3030
Mailing Address - Street 1:85 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:586-779-3030
Mailing Address - Fax:586-779-6733
Practice Address - Street 1:85 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:586-779-3030
Practice Address - Fax:586-779-6733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAISSANCE PLASTIC SURGERY P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3078606Medicaid
MIOEO1025OtherBLUE CROSS
MI1447266945OtherNPI
MI4134951Medicaid
MI1710993217OtherNPI
MI1447266945OtherNPI
MI4134951Medicaid
MI1710993217OtherNPI