Provider Demographics
NPI:1740533892
Name:FACIAL SURGERY INSTITUTE, PLC
Entity type:Organization
Organization Name:FACIAL SURGERY INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DMD,FACS,FRCS
Authorized Official - Phone:906-225-5959
Mailing Address - Street 1:1029 LINCOLN AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2679
Mailing Address - Country:US
Mailing Address - Phone:906-225-5959
Mailing Address - Fax:
Practice Address - Street 1:1029 LINCOLN AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2679
Practice Address - Country:US
Practice Address - Phone:906-225-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5520044OtherBLUE CROSS BLUE SHIELD