Provider Demographics
NPI:1689043895
Name:CENTER FOR COSMETIC SURGERY, PC
Entity Type:Organization
Organization Name:CENTER FOR COSMETIC SURGERY, PC
Other - Org Name:THE MICHIGAN CENTER FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:TRANG
Authorized Official - Last Name:SOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-930-0892
Mailing Address - Street 1:536 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2349
Mailing Address - Country:US
Mailing Address - Phone:248-930-0892
Mailing Address - Fax:
Practice Address - Street 1:8384 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1976
Practice Address - Country:US
Practice Address - Phone:810-606-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016929208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty