Healthcare Provider Details

I. General information

NPI: 1669109823
Provider Name (Legal Business Name): MICHIGAN SURGERY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 E OLD US HIGHWAY 12 STE 302
CHELSEA MI
48118-1805
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 210
WARREN MI
48093-2547
US

V. Phone/Fax

Practice location:
  • Phone: 248-450-2020
  • Fax:
Mailing address:
  • Phone: 115-864-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHELE L KUDLOR
Title or Position: BILLING MANAGER
Credential:
Phone: 586-558-9705