Provider Demographics
NPI:1255003893
Name:ADVANCED PLASTIC SURGERY, PC
Entity Type:Organization
Organization Name:ADVANCED PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOMOROWSKA-TIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-323-3102
Mailing Address - Street 1:3855 BURTON ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6147
Mailing Address - Country:US
Mailing Address - Phone:616-323-3102
Mailing Address - Fax:616-323-3061
Practice Address - Street 1:3855 BURTON ST SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6147
Practice Address - Country:US
Practice Address - Phone:616-323-3102
Practice Address - Fax:616-323-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty