Provider Demographics
NPI:1851539357
Name:ETI GURSEL MD PC
Entity Type:Organization
Organization Name:ETI GURSEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ETI
Authorized Official - Middle Name:
Authorized Official - Last Name:GURSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-358-0011
Mailing Address - Street 1:3100 CHESTNUT RUN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1111
Mailing Address - Country:US
Mailing Address - Phone:248-358-0011
Mailing Address - Fax:248-358-1491
Practice Address - Street 1:26699 W 12 MILE RD
Practice Address - Street 2:SUITE 201 248-358-1491
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-358-0011
Practice Address - Fax:248-358-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty