Provider Demographics
NPI:1841219037
Name:CENTER FOR PLASTIC SURGERY ANN ARBOR, P.C.
Entity Type:Organization
Organization Name:CENTER FOR PLASTIC SURGERY ANN ARBOR, P.C.
Other - Org Name:CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAILOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-712-7087
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE R5001
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-2323
Mailing Address - Fax:734-712-2312
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE R5001
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-2323
Practice Address - Fax:734-712-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG06651OtherBLUE CARE NETWORK
MI240H110560OtherBLUE CROSS BLUE SHIEL
MIG06651OtherBLUE CARE NETWORK
MIOM54930Medicare ID - Type UnspecifiedMEDICARE ID1