Provider Demographics
NPI:1629084991
Name:MINDLIN-KOH CENTER FOR OPHTHALMIC MEDICINE AND SURGERY PC
Entity Type:Organization
Organization Name:MINDLIN-KOH CENTER FOR OPHTHALMIC MEDICINE AND SURGERY PC
Other - Org Name:MICHIGAN OPHTHALMIC PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-334-4906
Mailing Address - Street 1:1750 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0179
Mailing Address - Country:US
Mailing Address - Phone:248-334-4906
Mailing Address - Fax:
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0179
Practice Address - Country:US
Practice Address - Phone:248-334-4906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP12610Medicare ID - Type Unspecified