Provider Demographics
NPI:1669658563
Name:PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.
Entity Type:Organization
Organization Name:PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON WITH HAND SPECIALTY
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMOTSUMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAKHENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-606-8200
Mailing Address - Street 1:PO BOX 1232
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48480-3232
Mailing Address - Country:US
Mailing Address - Phone:810-606-8200
Mailing Address - Fax:810-606-8282
Practice Address - Street 1:9450 S SAGINAW RD STE F
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8206
Practice Address - Country:US
Practice Address - Phone:810-606-8200
Practice Address - Fax:810-606-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0986343OtherHP
MI50015979OtherHEALTH ALLIANCE PLAN
MI4250386Medicaid
MIC6904OtherMCARE
MI0250494OtherBN
MI1001506OtherMCLAREN HEALTH PLAN
MI0250494OtherBCBS
MI0986343OtherHP
MIC6904OtherMCARE