Provider Demographics
NPI:1497425508
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?:Yes
Parent Organization LBN:ADVANCED PLASTIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical