Provider Demographics
NPI:1609344175
Name:ALBERTO J AVILES MD, PLLC
Entity Type:Organization
Organization Name:ALBERTO J AVILES MD, PLLC
Other - Org Name:SKYLINE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-936-0067
Mailing Address - Street 1:29201 TELEGRAPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7645
Mailing Address - Country:US
Mailing Address - Phone:248-936-0067
Mailing Address - Fax:248-716-5955
Practice Address - Street 1:29201 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7645
Practice Address - Country:US
Practice Address - Phone:248-936-0067
Practice Address - Fax:248-716-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty