Provider Demographics
NPI:1689777252
Name:PLASTIC & COSMETIC SURGEONS PC
Entity Type:Organization
Organization Name:PLASTIC & COSMETIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:POLETES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-485-3583
Mailing Address - Street 1:1219 EAST SAGINAW STREET
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906
Mailing Address - Country:US
Mailing Address - Phone:517-485-3583
Mailing Address - Fax:517-485-3942
Practice Address - Street 1:1219 EAST SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906
Practice Address - Country:US
Practice Address - Phone:517-485-3583
Practice Address - Fax:517-485-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP0697772082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1300066OtherPHP
MI24033111081OtherBCBS
MI24033111081OtherBCBS