Provider Demographics
NPI:1790009512
Name:COSMETIC & PLASTIC SURGERY CLINIC, P.C.
Entity Type:Organization
Organization Name:COSMETIC & PLASTIC SURGERY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DIXIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-9770
Mailing Address - Street 1:37300 GARFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2051
Mailing Address - Country:US
Mailing Address - Phone:586-263-9770
Mailing Address - Fax:586-263-9770
Practice Address - Street 1:37300 GARFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2051
Practice Address - Country:US
Practice Address - Phone:586-263-9770
Practice Address - Fax:586-263-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVD039924208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2591164Medicaid
MI0500046Medicare PIN
MIE40155Medicare UPIN