Healthcare Provider Details

I. General information

NPI: 1306616487
Provider Name (Legal Business Name): MCGINNISS PLASTIC SURGERY AND AESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8546 W GRAND RIVER AVE
BRIGHTON MI
48116-2326
US

IV. Provider business mailing address

8546 W GRAND RIVER AVE
BRIGHTON MI
48116-2326
US

V. Phone/Fax

Practice location:
  • Phone: 810-316-5077
  • Fax:
Mailing address:
  • Phone: 810-316-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT MCGINNISS
Title or Position: OWNER
Credential: DO
Phone: 810-316-5077