Provider Demographics
NPI:1720538341
Name:SOUTHWEST MICHIGAN PLASTIC AND HAND SURGERY, PC
Entity Type:Organization
Organization Name:SOUTHWEST MICHIGAN PLASTIC AND HAND SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-273-9789
Mailing Address - Street 1:7971 MOORSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4075
Mailing Address - Country:US
Mailing Address - Phone:269-329-2900
Mailing Address - Fax:269-329-1408
Practice Address - Street 1:7971 MOORSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4075
Practice Address - Country:US
Practice Address - Phone:269-329-2900
Practice Address - Fax:269-329-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty